[Cost reduction in the assessment of thoracic pain with the chest pain unit in first aid].
BACKGROUND
The evaluation of chest pain is a constant challenge for cardiologists, due to its clinical, organizational, economical and legal implications. The costs of the diagnostic classification of non-specific thoracic pain during ordinary, albeit short, hospitalization are here compared with a quick screening of the same symptoms in a "Chest Pain Unit", which may form an appendix of the emergency room (ER).


METHODS
The study involves patients admitted to the hospital used as reference during the year 2000 and discharged with a diagnosis of thoracic pain or precordial pain, as identified by ICD-9-CM codes 786.50, 786.51, 786.52, 786.59. According to DRG 143 tariffs, the hospitalization of such a patient costs Itl 4,346,000 epsilon 2244.52). If a Chest Pain Unit should monitor the same patients in the ER for at least 12 hours, during which time the examination at admission has to followed by two ECGs, 4 seriated evaluation of cardio-specific enzymes, an echocardiogram and a stress test, the individual cost concerning payment for ER services, would be of Itl 879,000 ([symbol: see text] 453.97). Even adding Itl 508,000 ([symbol: see text] 262.36) to pay the 12-hour monitoring provided for by the short protocol, the total amount would be Itl 1,387,000 epsilon 716.33). This evaluation has also been applied to the 47,775 patients hospitalized with the same diagnosis in all Italian hospitals during the year 1999.


RESULTS
Three hundred and thirty-eight patients admitted to the hospital used as reference were discharged with the above reported diagnosis. Among them 215 (64%) were hospitalized in the cardiology ward. The total cost for hospitalization for the 338 patients evaluated was Itl 1,468,948,000 epsilon 758,648.33) as compared to Itl 297,102,000 epsilon 153,440.37) that the short-term therapy would have required. Countrywide the same cost was Itl 207,543,230,000 epsilon 107,187,132.99) as compared to Itl 41,976,645,000 epsilon 21,679,127.91) for the short-term therapy, using which would have led to save Itl 166,566,585,000 epsilon 86,024,461.98).


CONCLUSIONS
The suggested strategy, corroborated by many previous experiences, is an effective and efficient alternative for thoracic pain evaluation, especially in a time when economical resources are being drastically reduced, thus requiring research and application of optimized diagnostic procedures.
Mauri
Francesco
F
Dipartimento Cardiologico A. De Gasperis, Ospedale Niguarda Ca' Granda, Milano. fmauri@tiscalinet.it
Mafrici
Antonio
A
Pirelli
Salvatore
S
Doneda
Renzo
R
D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology*; D003325:Coronary Care Units / Q000191:economics*; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital; D005260:Female; D005392:First Aid; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged
Riduzione dei costi nella valutazione del dolore toracico con la "Chest Pain Unit" in Pronto Soccorso.