title: Yield of diagnostic tests and its impact on cost in adult patients with syncope presenting to a community hospital.
abstract: OBJECTIVE
  Total annual costs for syncope-related hospitalizations were $2.4 billion in 2000. The aim of this study was to examine the type and number of tests ordered for patients admitted with syncope and whether these tests helped establish the cause.
  
  
  METHODS
  We studied the records of 1038 patients coded as "syncope" in billing records, and 167 fulfilled the eligibility criteria. The main outcome measures were the diagnostic yield of the ordered tests, the incremental cost/incremental benefit, and the number of admissions that can be averted if risk stratification were used in the evaluation.
  
  
  RESULTS
  The etiology of the syncope was identified in 48.3% of the patients. Postural blood pressure measurement has the highest diagnostic yield at 58.7%, whereas history taking diagnosed 19.7% of cases. The diagnostic yields of telemetry, electrocardiogram, radionuclide stress test, echocardiography, and troponin measurement were 4.76%, 4.24%, 3.44%, 0.94%, and 0.62%, respectively. Chest x-ray, carotid ultrasonography, 24-hour Holter monitoring, brain computed tomography, and brain magnetic resonance imaging did not yield the diagnosis in any of the patients. Only 1.9% of the money spent in the evaluation of syncope was effective in leading to a definitive diagnosis. The orthostatic blood pressure measurement was ranked first in the incremental cost/incremental benefit ratio and the radionuclide stress test was ranked last (17.03 vs 42,369.0, respectively). Approximately 6% of the patients did not meet the admission criteria.
  
  
  CONCLUSIONS
  Physicians ordered unnecessary tests that have a low yield and are not cost-effective. A standardized algorithmic approach should be the cornerstone in the evaluation of syncope.
authors.affiliation: From the University of Texas Health Science Center at Houston, and the Cairo University School of Medicine, Cairo, Egypt.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Johnson
authors.affiliation: From the University of Texas Health Science Center at Houston, and the Cairo University School of Medicine, Cairo, Egypt.
authors.forename: Hussam
authors.initials: H
authors.lastname: Ammar
authors.affiliation: From the University of Texas Health Science Center at Houston, and the Cairo University School of Medicine, Cairo, Egypt.
authors.forename: Wael
authors.initials: W
authors.lastname: Zohdy
authors.affiliation: From the University of Texas Health Science Center at Houston, and the Cairo University School of Medicine, Cairo, Egypt.
authors.forename: Ragai
authors.initials: R
authors.lastname: Fouda
authors.affiliation: From the University of Texas Health Science Center at Houston, and the Cairo University School of Medicine, Cairo, Egypt.
authors.forename: Rukma
authors.initials: R
authors.lastname: Govindu
mesh_terms: D000328:Adult; D000368:Aged; D017281:Cost of Illness; D006760:Hospitalization / Q000191:economics*; D006764:Hospitals, Community / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013575:Syncope / Q000175:diagnosis* / Q000191:economics*; D019564:Unnecessary Procedures / Q000191:economics* / Q000706:statistics & numerical data*