Ahmet KARAMERCAN, Utku YILMAZ, Gülbin AYGENCEL, Mehmet KARAMERCAN, Mustafa N. İLHAN

Acil serviste karın ağrısını değerlendirmenin maliyeti

Amaç: Bu çalısmanın amacı acil servislere travma dısı karın ağrısı (TDKA) ile basvuran hastalarda yapılan tanısal ve tedavisel islemlerin maliyetinin hesaplanması vebu maliyeti etkileyen faktörlerin belirlenmesidir. Gereç ve Yöntem : Bu çalısmaya acil servisimize TDKA ile basvuran, çalısma kriterlerine uyan ve katılmayı kabul eden 345 hasta alınmıstır. Hastalar acil servistenayrıldıktan sonra tanı ve tedavi harcamaları hesaplanmıstır. Bu harcama tutarlarıözellikle yas, cinsiyet ve altta yatan hastalığa göre olusturulan gruplarda karsılaştırılmıstır. Bulgular: Çalısma grubunun %60’ı kadındır. Hastaların yas ortalaması 36,5 yıldır(17-92 yıl). TDKA hastalarının acil serviste ortalama kaldıkları süre 4,92 saattir(1-151 saat). TDKA hastalarının acil servis harcamaları tutarı ise ortalama 112,2TL’dir (14-1394 TL). Bu çalısmada 60 yas üzerinde olmanın, karın ağrısına eslikeden ek semptomların var olmasının, cerrahi karın ağrısı olmasının, baska bir merkezden karın ağrısı ile acil servise gönderiliyor olmanın ve tekrarlayan karın ağrısı ileacil servise basvurmanın acildeki izlem süresini ve maliyeti artırdığı belirlenmistir. Sonuç: TDKA’na yaklasımda maliyeti belirleyen çalısmaların, etkin maliyet stratejilerinin belirlenmesinde ve basvuru klavuzlarının hazırlanmasında dikkate alınmasıgerekmektedir

Cost of the management of abdominal pain in the emergency room

Purpose: To estimate the cost of the diagnosis and management of nontraumat abdominal pain (NTAP) in the emergency room (ER) and to determine the facto that affect the cost of diagnosis and management of this type of pain. Materials and Methods: In total 345 patients with NTAP and complying with th study criteria were included. After they discharged from the ER, the expenses o diagnosis and treatment of the patients were calculated. The expense results we compared to each other especially in terms of age, sex, and underlying disease. Results: In the study group, 60% of patients were female. The mean age of the pat ents was 36.5 (range: 17-92). The overall mean time of the patients with NTAP spe in the ER was 4.92 h (range: 1-151 h). The mean expense amount of the patients wi NTAP in ER was 112.2 TL (range: 14-1394 TL). Being above the age of 60, havin accompanying symptoms, having surgical abdominal pain, having pathological fin dings in abdominal examinations, and being referred from other centers or bein referred back to the ER with the same complaint were the most important factors th determined the follow-up period and expenses of NTAP patients in the ER. Conclusion: Such information describing the cost of diagnosis and management o NTAP should be taken into account to determine cost effective strategies and to e tablish reference guidelines.

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1. Gill BD, Jenkins JR. Cost effective evaluation and management of the acute abdomen. Surg Clin North Am 1996; 76:71-82.
2. Marincek B. Nontraumatic abdominal emergencies: acute abdominal pain: diagnostic strategies. Eur Radiol 2002; 12: 2136-2150.
3. American College of Emergency Physicians. Clinical policy: critical issues for the initial evaluation and management of patients presenting with a chief complaint of nontraumatic acute abdominal pain. Ann Emerg Med 2000; 36: 44.
4. Jess P, Bjerregaard B, Brynitz S, et al. Prognosis of acute nonspecific abdominal pain: A prospective study. Am J Surg 1982; 144: 338-340.
5. van Geloven AA, Biesheuvel TH, Luitse JS, et al. Hospital admission of patients aged over 80 with acute abdominal complaints. Eur J Surg 2000; 166: 866-871.
6. Marco CA, Schoenfeld CN, Keyl PM, et al. Abdominal pain in geriatric emergency patients: variables associated with adverse outcomes. Acad Emerg Med 1998; 5: 1163-1168.
7. de Dombal FT. Acute abdominal pain in the elderly. J Clin Gastroen- terol 1994; 19: 331-335.
8. Kizer KW, Vassar MJ. Emergency department diagnosis of abdominal disorders in the elderly. Am J Emerg Med 1998; 16: 357-362.
9. Gerhardt RT, Nelson BK, Keenan ST, et al. Derivation of a clinical guideline for the assessment of nonspecific abdominal pain: the Guideline for Abdominal Pain in the ED setting (GAPEDS) Phase 1 Study. Am J Emerg Med 2005; 23: 709-717.
10. Driscoll PA, Vincent CA, Servant CJ, et al. Use of advisers in the diagnosis and management of abdominal pain in accident and emergency departments. Br J Surg 1988; 75: 1173-1175.
11. Sox CM, Burstin HR, Orav EJ, et al. The effect of supervision of residents on quality of care in five university-affiliated emergency departments. Acad Med 1998; 73:776-782.
12. Nagurney JT, Brown DF, Chang Y, et al. Use of diagnostic testing in the emergency department for patients presenting with nontraumatic abdominal pain. J Emerg Med 2003; 25: 363-371.
13. Anyanwu AC, Moalypour SM. Are abdominal radiographs still overutilized in the assessment of acute abdominal pain? A district general hospital audit. JR Coll Surg Edinb 1998; 43: 267-270.
14. Feyler S, Williamson V, King D. Plain abdominal radiographs in acute medical emergencies; an abused investigation? Postgrad Med J 2002; 78: 94-96.
15. Vairo G, Salustri A, Trambqiolo P, et al. Emergency department ultrasonography: impact on patient management and cost effectiveness. Minerva Med 2003; 94: 347-352.
16. Mindelzun RE, Jeffrey RB. Unenhanced helical CT for evaluating acute abdominal pain: a little more cost, a lot more information. Radiology 1997; 205: 43-45.
17. Nagurney JT, Brown DF, Novelline RA, et al. Plain abdominal radiographs and abdominal CT scans for nontraumatic abdominal painadded value? Am J Emerg Med 1999; 17: 668-671.
18. Roth C, Tello R, Sutherland K, et al. Prediction rule for etiology of vague abdominal pain in the emergency room: utility for imaging triage. Invest Radiol 2002; 37: 552-556.
19. Guillemin F, Cao MM, Girard F, et al. Cost of medical imaging practices in acute abdominal syndromes. Arch Intern Med 2003; 163: 929-935.
20. Kamin RA, Nowicki TA, Courtney DS, et al. Pearls and pitfalls in the emergency department evaluation of abdominal pain. Emerg Med Clin N Am 2003; 21: 61-72.
21. Weiner JB, Nagurney JT, Brown DF, et al. Duration of symptoms and follow up patterns of patients discharged from the emergency department after presenting with abdominal or flank pain. Family Practice 2004; 21: 314-316.
22. Lukens TW, Emerman C, Effron D. The natural history and clinical findings in undifferentiated abdominal pain. Ann Emerg Med 1993; 22:690- 696.