A new study reveals that over 20% of patients with certain health conditions in England are being diagnosed as an emergency, associated with a higher risk of death and longer hospital stays in the year after the diagnosis.

Supported by HDR UK, researchers at University College London (UCL) looked at how often 13 health conditions are first diagnosed as an emergency – during or soon after an emergency hospital admission or A&E attendance, rather than through routine or planned healthcare services. At least 20% of patients were found to be diagnosed as an emergency for nine of the conditions, including over 30% with Parkinson’s disease and 35% with chronic obstructive pulmonary disease (COPD).

The study, published in PLOS Medicine, analysed data from over 1.7 million patients diagnosed with one of the 13 conditions between 1999 and 2019. Across most health conditions, patients diagnosed as an emergency were more likely to die and spent more time in hospital over the following year compared to patients diagnosed in other ways.

First author Dr Emma Whitfield, Research Fellow at UCL, said: “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.”

A wide range of health conditions were included in the study:

  • Inflammatory conditions like inflammatory bowel disease (IBD), axial spondyloarthritis, rheumatoid arthritis and coeliac disease
  • Neurological conditions, such as multiple sclerosis (MS) and Parkinson’s disease, and schizophrenia – a mental health condition
  • Infectious diseases such as tuberculosis, subacute bacterial endocarditis and Lyme disease
  • Other conditions included coronary/ischaemic heart disease, chronic obstructive pulmonary disease (COPD) and polyendocrine metabolic ovarian syndrome (PMOS), previously known as polycystic ovary syndrome (PCOS)

After accounting for factors such as age, year of diagnosis, socioeconomic deprivation, having multiple medical conditions (co-morbidity) and the healthcare setting, emergency diagnosis remained strongly associated with an increased risk of death within one year. This association was seen even in conditions that generally have a good prognosis, such as coeliac disease and IBD.

Previous research has shown that people diagnosed with cancer during or soon after emergency hospital care often have a more advanced stage of the disease and poorer outcomes. However, less is known about how often this happens, or its impact, in other health conditions.

Georgios Lyratzopoulos, senior author and Professor of Cancer Epidemiology at UCL, said: “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.”

This study used data provided by patients and collected by the NHS as part of their care and support, including securely accessed linked primary care data from Clinical Practice Research Datalink (CPRD) as well as secondary care data (Hospital Episode Statistics) and death records from the Office for National Statistics.

Future research is needed to understand the factors that contribute to emergency diagnosis and how they can be addressed to improve patient care.