Patients diagnosed with conditions after an emergency hospital admission or an emergency room visit face a higher risk of death than those diagnosed in non-emergency settings, according to a large population-based study by Emma Whitfield and colleagues from University College London, UK, published August 25th in the open access journal PLOS Medicine.
Cancer diagnoses following emergency hospital care are known to be associated with advanced disease and poor prognosis. However, less is known about the frequency and prognostic outcomes of emergency diagnosis in other conditions.
Using linked primary care, hospital, and mortality records from England for 1.7 million patients diagnosed with one of 13 conditions between 1999 and 2019, the researchers assessed how often patients received a diagnosis following emergency hospital care and compared subsequent outcomes with those of patients diagnosed through non-emergency routes. Conditions included chronic obstructive pulmonary disease (COPD), inflammatory bowel disease (IBD), Parkinson's disease, multiple sclerosis (MS), rheumatoid arthritis, celiac disease, and schizophrenia.
Emergency diagnosis was common across multiple conditions. More than one in five patients were diagnosed following an emergency presentation in nine of the 13 conditions examined, including more than 30% of patients with Parkinson's disease and 35% of those with COPD. Across most conditions, patients diagnosed as an emergency experienced substantially poorer outcomes, including higher mortality and longer hospital stays during the year after diagnosis.
After accounting for factors such as age, year of diagnosis, socioeconomic deprivation, comorbidities, and healthcare setting, emergency diagnosis remained strongly associated with an increased risk of death within one year. This association was evident even in conditions that generally have a favorable prognosis, including celiac disease and IBD.
The study shows that emergency diagnosis is a common phenomenon across diverse diseases and is consistently associated with worse outcomes. Future research is needed to understand disease-specific and broader health system factors that contribute to emergency diagnosis as well as whether reducing emergency diagnoses or improving care for patients diagnosed through emergency pathways can lead to better outcomes.
Dr Emma Whitfield, first author, states, "We showed that emergency diagnosis occurred across a wide range of conditions and was consistently associated with a greater risk of death and more time in hospital in the year after diagnosis. Often emergency diagnosis will represent the best standard of care, as illnesses can develop rapidly or have few warning signs. However, the scale of our findings suggest others may reflect difficulties obtaining timely assessment, investigation, or specialist care.
"Behind these figures are patients and families experiencing an unexpected hospital admission, a new diagnosis, and, sometimes, a much more difficult year afterwards.
"Understanding why emergency diagnosis happens could help us identify where earlier diagnosis may be possible or additional support might make a difference."
Prof Georgios Lyratzopoulos, senior author, notes, "Our study was triggered by a concept initially developed in the field of cancer epidemiology which we have applied across a diverse range of other conditions. The consistency of the findings suggests that emergency diagnosis deserves greater attention by researchers and policymakers across disease areas, and a health system-wide approach.
"Cancer policy has shown the value of monitoring emergency diagnosis, but there is currently little comparable evidence for other conditions. Our study provides a starting point for understanding the scale of the issue beyond cancer, although further research is needed before emergency diagnosis can be used as a quality measure in other disease areas."
In your coverage, please use this URL to provide access to the freely available paper in PLOS Medicine: https://plos.io/4b5JDfS
Citation: Whitfield E, White B, Barclay ME, Rafiq M, Zakkak N, Berglund M, et al. (2026) Frequency and prognostic outcomes of emergency diagnosis in 13 non-neoplastic conditions in England: A population-based cohort study using linked electronic health records of 1.7 million patients. PLoS Med 23(8): e1005182. https://doi.org/10.1371/journal.pmed.1005182
Author countries: United Kingdom, United States of America
Funding: EW acknowledges the receipt of a studentship award from the Health Data Research UK-The Alan Turing Institute Wellcome PhD Programme in Health Data Science (218529/Z/19/Z; https://wellcome.org/ ). This research relates to the International Alliance for Cancer Early Detection, a partnership between Cancer Research UK (C18081/A31373 to GL), Canary Center at Stanford University, the University of Cambridge, OHSU Knight Cancer Institute, University College London, and the University of Manchester. GL was supported by Cancer Research UK Clinician Advanced Scientist Fellowship C18081/A18180 for part of the project. GL and MEB are co-investigators of the National Institute for Health and Care Research Policy Research Programme Unit on Cancer Awareness, Screening and Early Diagnosis (PR-PRU-NIHR206132; https://www.nihr.ac.uk/ ). NZ is an employee of Cancer Research UK. The funders had no other role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
