Calkins H, Byrne M, el-Atassi R, Kalbfleisch S, Langberg J J, Morady F
Division of Cardiology, University of Michigan Medical Center, Ann Arbor.
Am J Med. 1993 Nov;95(5):473-9. doi: 10.1016/0002-9343(93)90329-n.
The objective of this study was to describe the cost of prior diagnostic evaluation in patients referred for evaluation of syncope whose history was typical of vasodepressor syncope.
Thirty consecutive patients who were referred for evaluation of syncope of undetermined origin and whose history was highly suggestive of vasodepressor syncope participated in this study. These 30 patients represented 19% of 158 patients referred for evaluation of syncope during the period of enrollment. All patients had positive results of an upright-tilt test, confirming the diagnosis of vasodepressor syncope. At the time of evaluation, the type and results of all diagnostic tests that had been performed prior to referral were recorded for each patient. The cost of diagnostic testing was then determined based on the 1991 cost of these tests at the University of Michigan Medical Center. A mean of 4 +/- 2 major diagnostic tests were performed before referral to the University of Michigan Medical Center. The mean and median costs of diagnostic testing per patient prior to referral were $3,763 +/- 3,820 and $2,678 (range: 0 to $16,606) respectively. Six patients underwent no major diagnostic tests prior to referral and, therefore, the cost of major diagnostic testing was zero in these patients. In the remaining patients, the mean and median costs of diagnostic testing per patient were $4,704 +/- 3,713 and $3,777 (range: $1,025 to $16,606) respectively.
The results of this study demonstrate that a diagnosis of vasodepressor syncope can be established clinically in approximately 20% of patients referred to a university hospital for evaluation of syncope of undetermined origin. Failure to recognize the clinical features of vasodepressor syncope in these patients resulted in up to $16,000 of unnecessary diagnostic testing. A greater awareness of the clinical features of vasodepressor syncope may, therefore, result in significant economic savings.
本研究的目的是描述因不明原因晕厥而转诊、病史典型为血管迷走性晕厥患者先前诊断评估的费用。
30例因不明原因晕厥而转诊、病史高度提示血管迷走性晕厥的连续患者参与了本研究。这30例患者占入选期间转诊进行晕厥评估的158例患者的19%。所有患者直立倾斜试验结果均为阳性，确诊为血管迷走性晕厥。在评估时，记录了每位患者转诊前进行的所有诊断检查的类型和结果。然后根据1991年密歇根大学医学中心这些检查的费用确定诊断检查的费用。转诊至密歇根大学医学中心之前，每位患者平均进行了4±2项主要诊断检查。转诊前每位患者诊断检查的平均费用和中位数费用分别为3763±3820美元和2678美元（范围：0至16606美元）。6例患者转诊前未进行主要诊断检查，因此这些患者的主要诊断检查费用为零。在其余患者中，每位患者诊断检查的平均费用和中位数费用分别为4704±3713美元和3777美元（范围：102美元至16606美元）。
本研究结果表明，在转诊至大学医院进行不明原因晕厥评估的患者中，约20%可通过临床诊断血管迷走性晕厥。未能识别这些患者血管迷走性晕厥的临床特征导致了高达16000美元的不必要诊断检查。因此，提高对血管迷走性晕厥临床特征的认识可能会显著节省费用。
