Yonsei Med J.  2012 May;53(3):517-523. 10.3349/ymj.2012.53.3.517.

Diagnostic Patterns in the Evaluation of Patients Presenting with Syncope at the Emergency or Outpatient Department

• Kang GH
• Oh JH
• Kim JS
• On YK
• Song HG
• Jo IJ
• Kim SJ
• Bae SJ
• Shin TG

• KMID: 1776985
• DOI: http://doi.org/10.3349/ymj.2012.53.3.517

Abstract

PURPOSE
Patterns of syncope evaluation vary widely among physicians and hospitals. The aim of this study was to assess current diagnostic patterns and medical costs in the evaluation of patients presenting with syncope at the emergency department (ED) or the outpatient department (OPD) of a referral hospital.
MATERIALS AND METHODS
This study included 171 consecutive patients with syncope, who visited the ED or OPD between January 2009 and July 2009.
RESULTS
The ED group had fewer episodes of syncope [2 (1-2) vs. 2 (1-5), p=0.014] and fewer prodromal symptoms (81.5% vs. 93.3%, p=0.018) than the OPD group. Diagnostic tests were more frequently performed in the ED group than in the OPD group (6.2+/-1.7 vs. 5.3+/-2.0; p=0.012). In addition, tests with low diagnostic yields were more frequently used in the ED group than in the OPD group. The total cost of syncope evaluation per patient was higher in the ED group than in the OPD group [823000 (440000-1408000) won vs. 420000 (186000-766000) won, p<0.001].
CONCLUSION
There were some differences in the clinical characteristics of patients and diagnostic patterns in the evaluation of syncope between the ED and the OPD groups. Therefore, a selective diagnostic approach according to the presentation site is needed to improve diagnostic yields and to reduce the time and costs of evaluation of syncope.

Keyword

Syncope; diagnosis; cost-benefit analysis

MeSH Terms

Adult
Cost-Benefit Analysis
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Syncope/*diagnosis

Figure

• 

  Fig. 1 Comparison of frequently performed tests between the ED and OPD groups (n=171). ED, emergency department; OPD, outpatient department; BP, blood pressure; ECG, electrocardiogram; HUTT, head up tilt test; TMT, treadmill test; CT, computerized tomography; MRI, magnetic resonance imaging; CXR, chest X-ray.

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