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Acil Servise Baş Dönmesi Şikayeti ile Başvuran Hastalarda Nörogörüntüleme Maliyeti

Yıl 2019, , 315 - 320, 31.12.2019
https://doi.org/10.16899/jcm.684344

Öz

Amaç: Pek çok hastalığın baş dönmesi belirtisi vermesi ve bunlardan bazılarının hayatı tehdit edici nitelikte oluşu acil servislerde baş dönmesi yönetimini zorlaştırmaktadır. Bu zorluklara paralel olarak da tanıda nörogörüntüleme kullanım sayısı giderek artmaktadır. Bu çalışmada baş dönmesi şikayeti ile acil servise başvuran hastaların nörogörüntüleme maliyetleri açısından değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışma hastanemiz Acil Tıp Kliniğine 01.01.2013-31.12.2013 tarihleri arasında ana şikayeti baş dönmesi olan hastaların dosyalarının geriye dönük incelenmesi ile yürütüldü. Tüm hastaların dosya bilgilerinden yaş, cinsiyet, anamnez, tanısal tetkikler ve yapılan tetkiklerin maliyeti veri toplama formlarına kaydedildi. Hastaların acil servis sonuç tanıları santral nedenli baş dönmesi, periferik nedenli baş dönmesi, kardiak ve tansiyon nedenli baş dönmesi, dahili nedenlere bağlı baş dönmesi, psikojenik nedenli baş dönmesi ve diğer nedenler olmak üzere 6 grupta sınıflandırıldı. Bu grupların maliyetleri ve toplam maliyet tespit edilerek oranları istatistiksel olarak incelendi.
Bulgular: Çalışmaya alınan 381 hastanın %59.8’i kadın (n:228), %40.2’si erkek (n:153) olup yaş ortalamaları 46,12+18,92 idi. Tanılarına göre gruplandırıldığında santral nedenli baş dönmesi grubunda 31 (%8.1), periferik grupta 175 (%45.9), kardiyak veya tansiyon nedenli grupta 43 (%11.2), dahili nedenli grupta 18 (%4.7), psikojenik grupta 6 (%1.5) ve diğer nedenli grupta 108 (%28.3) hasta yer aldı. Tüm hastaların 72’sine (%18.8) BT, 35’ine (%9.1) MRG çekildiği gözlendi. En fazla santral nedenli gruba nörogörüntüleme yapıldığı görüldü (BT %41.9, MRG %32.2). Nörogörüntüleme maliyetinin en yüksek olduğu grup, periferik vertigo grubunda idi. Ancak hasta başı maliyet hesap edildiğinde, bir hastanın maliyetinin en az olduğu grup periferik vertigo grubuydu.
Sonuç: Acil servise baş dönmesi şikayeti ile başvuran hastaların yıl geçtikçe artması ve hekimlerin önemli bir patolojiyi atlamak istememesi nedeniyle bu hastaların hastane maliyetinin giderek arttığı bilinmektedir. Bu çalışma Türkiye’de acil servisteki baş dönmesi başvurularında maliyet analizinin yapıldığı ilk çalışmadır. Gereksiz maliyeti önlemek; geliştirilecek olan algoritmalarla birlikte, acil serviste iyi ve doğru bir hasta yönetimi ile mümkün olabilir.

Kaynakça

  • 1. Navi B.B., Kamel H., Shah M.P., Grossman A.W. Rate and predictors of serious neurological causes of vertigo in the emergency department. Mayo Clin Proc, 2012. 87(11): p. 1080-8.
  • 2. Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67-82. Review.
  • 3. Kroenke K., Hoffman R.M., and Einstadter D. How common are various causes of vertigo? A critical review. South Med J, 2000; 93(2),160-7.
  • 4. Ozakin E., Coskun F., Sarac S. Value of magnetic resonance imaging and audiology in the emergency department in differential diagnosis of peripheral and central vertigo. Turkiye Klinikleri J of Med Sci, 2012; 32(1): 1-6.
  • 5. Post R.E. and Dickerson L.M. Vertigo: A diagnostic approach. Am Fam Physician, 2010; 82(4): 361-368.
  • 6. Collie M.J.H. and Ramsey A.R. Differentiating Benign Paroxysmal Positional Vertigo from Other Causes of Vertigo. JNP, 2014; 10(6): 393-400.
  • 7. Kim A.S., Fullerton H.J. and Johnston S.C. Risk of vascular events in emergency department patients discharged home with diagnosis of vertigo or vertigo. Ann Em Med, 2011; 57(1): 34-41.
  • 8. Neuhauser H.K., Von Brevern M., Radtke A., Lezius F. Epidemiology of vestibular vertigo: A neurotologic survey of the general population. Neurology, 2005; 65(6): 898-904.
  • 9. Karatas M. Central vertigo and vertigo: epidemiology, differential diagnosis, and common causes. The Neurologist, 2008; 14(6): 355-364.
  • 10. Yardley L., Owen N., Nazareth I., Luxon L., Prevalence and presentation of vertigo in a general practice community sample of working age people. Br J Gen Prac, 1998; 48(429): 1131-1135.
  • 11. Kroenke K., Lucas C.A., Rosenberg M.L., Causes of persistent vertigo: a prospective study of 100 patients in ambulatory care. Ann of Int Med, 1992; 117(11): 898-904.
  • 12. Kim A.S., Sidney S., Klingman J.G., Johnston S.C., Practice variation in neuroimaging to evaluate vertigo in the ED. The Am J Emerg Med, 2012; 30(5): 665-672.
  • 13. Wasay M., Dubey N., and Bakshi R., Vertigo and yield of emergency head CT scan: is it cost effective? EMJ, 2005; 22(4): 312-314.
  • 14. Fiebach J., Schellinger P.D., Jansen O., Meyer M., CT and diffusion-weighted MR imaging in randomized order Diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke, 2002; 33(9): 2206-2210.
  • 15. Bryan R.N., Levy L.M., Whitlow W.D., Diagnosis of acute cerebral infarction: comparison of CT and MR imaging. Am J Neurorad, 1991; 12(4), 611-620.
  • 16. Mohr J.P., Biller J., Hilal S.K., Yuh W.T.C., Tatemichi T.K., Magnetic resonance versus computed tomographic imaging in acute stroke. Stroke, 1995; 26(5):807-812.
  • 17. Warach S., Gaa J., Siewert B., Wielopolski P., Acute human stroke studied by whole brain echo planar diffusion‐weighted magnetic resonance imaging. Anns of Neurology, 1995; 37(2): 231-241.
  • 18. Newman-Toker D.E., Hsieh Y.H., Camargo C.A., Spectrum of vertigo visits to US emergency departments: cross-sectional analysis from a nationally representative sample. In Mayo Clinic Proceedings. 2008. Elsevier.
  • 19. Edlow J.A., Newman-Toker D.E. and Savitz S.I., Diagnosis and initial management of cerebellar infarction. The Lancet. Neurology, 2008; 7(10): 951-964.
  • 20. Kerber K.A., Brown D.L., Lisabeth L.D., Smith M.A., Stroke among patients with vertigo and imbalance in the emergency department: a population-based study. Stroke, 2006; 37(10),2484-7.
  • 21. Seemungal B.M. and Bronstein A.M., A practical approach to acute vertigo. Practical neurology, 2008; 8(4), 211-221.
  • 22. Labuguen R.H., Initial evaluation of vertigo. Am Fam Physician, 2006; 73(2):244-251.
  • 23. Gardner R.L., Sarkar U., Maselli J.H., Factors associated with longer ED lengths of stay. The Am J Emerg Med, 2007; 25(6):643-650.
  • 24. Saber Tehrani A.S., Coughlan D., Rising Annual Costs of Dizziness Presentations to US Emergency Departments. Acad Emerg Med. 2013 Jul;20(7):689-96.

Cost of Neuroimaging of Patients with Vertigo in Emergency Department

Yıl 2019, , 315 - 320, 31.12.2019
https://doi.org/10.16899/jcm.684344

Öz

Background and Aim: The fact that many diseases cause symptoms of vertigo and that some of them are life-threatening make it difficult to manage vertigo in emergency departments (ED). Parallel to these difficulties, the number of neuroimaging use in diagnosis is increasing. In this study, it is aimed to evaluate the neuroimaging costs of patients with vertigo in ED.
Methods: The study was carried out with a retrospective review of the files of the patients with vertigo who were admitted to ED between 01.01.2013 and 31.12.2013. Patients were classified into 6 groups; central, peripheral, cardiac and blood pressure-induced, induced by internal causes, psychogenic, and vertigo related to other causes. Costs and the total cost of these groups were determined and the ratios were analyzed statistically.
Results: Of the 381 patients; 31 (8.1%) patients were seen to be in the central, 175 (45.9%) in the peripheral vertigo. 72 of patients were seen to have been examined with computerized tomography (CT) and 35 with magnetic resonance imaging (MRI). Neuroimaging was observed to have been implemented mostly on the central induced group. The highest neuroimaging cost was in the peripheral vertigo group. However, when the cost per patient was calculated, the group with the lowest cost of each patient was the peripheral vertigo group.
Conclusion: This study is the first study in Turkey for the cost analysis patients with a complaint of vertigo in ED. Avoiding unnecessary costs, along with the algorithms to be developed, can be possible with good and accurate patient management in ED.

Kaynakça

  • 1. Navi B.B., Kamel H., Shah M.P., Grossman A.W. Rate and predictors of serious neurological causes of vertigo in the emergency department. Mayo Clin Proc, 2012. 87(11): p. 1080-8.
  • 2. Neuhauser HK. The epidemiology of dizziness and vertigo. Handb Clin Neurol. 2016;137:67-82. Review.
  • 3. Kroenke K., Hoffman R.M., and Einstadter D. How common are various causes of vertigo? A critical review. South Med J, 2000; 93(2),160-7.
  • 4. Ozakin E., Coskun F., Sarac S. Value of magnetic resonance imaging and audiology in the emergency department in differential diagnosis of peripheral and central vertigo. Turkiye Klinikleri J of Med Sci, 2012; 32(1): 1-6.
  • 5. Post R.E. and Dickerson L.M. Vertigo: A diagnostic approach. Am Fam Physician, 2010; 82(4): 361-368.
  • 6. Collie M.J.H. and Ramsey A.R. Differentiating Benign Paroxysmal Positional Vertigo from Other Causes of Vertigo. JNP, 2014; 10(6): 393-400.
  • 7. Kim A.S., Fullerton H.J. and Johnston S.C. Risk of vascular events in emergency department patients discharged home with diagnosis of vertigo or vertigo. Ann Em Med, 2011; 57(1): 34-41.
  • 8. Neuhauser H.K., Von Brevern M., Radtke A., Lezius F. Epidemiology of vestibular vertigo: A neurotologic survey of the general population. Neurology, 2005; 65(6): 898-904.
  • 9. Karatas M. Central vertigo and vertigo: epidemiology, differential diagnosis, and common causes. The Neurologist, 2008; 14(6): 355-364.
  • 10. Yardley L., Owen N., Nazareth I., Luxon L., Prevalence and presentation of vertigo in a general practice community sample of working age people. Br J Gen Prac, 1998; 48(429): 1131-1135.
  • 11. Kroenke K., Lucas C.A., Rosenberg M.L., Causes of persistent vertigo: a prospective study of 100 patients in ambulatory care. Ann of Int Med, 1992; 117(11): 898-904.
  • 12. Kim A.S., Sidney S., Klingman J.G., Johnston S.C., Practice variation in neuroimaging to evaluate vertigo in the ED. The Am J Emerg Med, 2012; 30(5): 665-672.
  • 13. Wasay M., Dubey N., and Bakshi R., Vertigo and yield of emergency head CT scan: is it cost effective? EMJ, 2005; 22(4): 312-314.
  • 14. Fiebach J., Schellinger P.D., Jansen O., Meyer M., CT and diffusion-weighted MR imaging in randomized order Diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke. Stroke, 2002; 33(9): 2206-2210.
  • 15. Bryan R.N., Levy L.M., Whitlow W.D., Diagnosis of acute cerebral infarction: comparison of CT and MR imaging. Am J Neurorad, 1991; 12(4), 611-620.
  • 16. Mohr J.P., Biller J., Hilal S.K., Yuh W.T.C., Tatemichi T.K., Magnetic resonance versus computed tomographic imaging in acute stroke. Stroke, 1995; 26(5):807-812.
  • 17. Warach S., Gaa J., Siewert B., Wielopolski P., Acute human stroke studied by whole brain echo planar diffusion‐weighted magnetic resonance imaging. Anns of Neurology, 1995; 37(2): 231-241.
  • 18. Newman-Toker D.E., Hsieh Y.H., Camargo C.A., Spectrum of vertigo visits to US emergency departments: cross-sectional analysis from a nationally representative sample. In Mayo Clinic Proceedings. 2008. Elsevier.
  • 19. Edlow J.A., Newman-Toker D.E. and Savitz S.I., Diagnosis and initial management of cerebellar infarction. The Lancet. Neurology, 2008; 7(10): 951-964.
  • 20. Kerber K.A., Brown D.L., Lisabeth L.D., Smith M.A., Stroke among patients with vertigo and imbalance in the emergency department: a population-based study. Stroke, 2006; 37(10),2484-7.
  • 21. Seemungal B.M. and Bronstein A.M., A practical approach to acute vertigo. Practical neurology, 2008; 8(4), 211-221.
  • 22. Labuguen R.H., Initial evaluation of vertigo. Am Fam Physician, 2006; 73(2):244-251.
  • 23. Gardner R.L., Sarkar U., Maselli J.H., Factors associated with longer ED lengths of stay. The Am J Emerg Med, 2007; 25(6):643-650.
  • 24. Saber Tehrani A.S., Coughlan D., Rising Annual Costs of Dizziness Presentations to US Emergency Departments. Acad Emerg Med. 2013 Jul;20(7):689-96.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Orjinal Araştırma
Yazarlar

Ali Kablan Bu kişi benim 0000-0003-2711-0034

Serhat Karaman

Nurşah Başol

Yayımlanma Tarihi 31 Aralık 2019
Kabul Tarihi 18 Aralık 2019
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

AMA Kablan A, Karaman S, Başol N. Cost of Neuroimaging of Patients with Vertigo in Emergency Department. J Contemp Med. Aralık 2019;9(4):315-320. doi:10.16899/jcm.684344