{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:18:20Z","timestamp":1787681900994,"version":"build-2784847793"},"reference-count":61,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["218529\/Z\/19\/Z"],"award-info":[{"award-number":["218529\/Z\/19\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C18081\/A31373"],"award-info":[{"award-number":["C18081\/A31373"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["C18081\/A18180"],"award-info":[{"award-number":["C18081\/A18180"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["PR-PRU-NIHR206132"],"award-info":[{"award-number":["PR-PRU-NIHR206132"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In patients with cancer, diagnosis through or soon after the use of emergency hospital care (\u2018emergency diagnosis\u2019) is associated with advanced disease and poor prognosis. The varied and complex reasons for emergency diagnoses\u2014including rapid disease progression, patient factors, and system delays\u2014are unlikely to be unique to cancer. However, little is known about the frequency and prognostic outcomes of emergency diagnosis in other conditions. We aimed to document the frequency of emergency diagnoses across various non-neoplastic conditions and examine the association of emergency diagnosis with clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>We analysed records from linked primary care, secondary care, and death data (Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics, Office for National Statistics) for 1,701,154 patients with one of 13 exemplar conditions (axial spondyloarthritis, coeliac disease, coronary\/ischaemic heart disease, chronic obstructive pulmonary disease (COPD), inflammatory bowel disease (IBD), Lyme disease, multiple sclerosis (MS), Parkinson\u2019s disease, polycystic ovary syndrome, rheumatoid arthritis, schizophrenia, subacute bacterial endocarditis, and tuberculosis) in England between 1999 and 2019. We examined the percentage of patients diagnosed as an emergency and compared their mortality and time in hospital in the year post-diagnosis with patients who were not diagnosed as an emergency. Emergency diagnosis occurred in at least 20% of patients for 9 out of 13 conditions in our sample, including more than 30% of patients with Parkinson\u2019s disease and 35% of patients with COPD. For 9 out of 13 conditions, there was a substantial increase (at least +10% difference) in 1-year mortality in patients diagnosed as an emergency versus patients who were not diagnosed as an emergency. After adjusting for age and year of diagnosis, deprivation, comorbidity burden, and the healthcare setting in which the diagnosis was made, patients diagnosed as an emergency were typically much more likely to die within one year. This association held even in conditions with generally good prognosis, such as coeliac disease (adjusted odds ratio 7.53, 95% CI [5.64, 10.1], women) and IBD (adjusted odds ratio 5.99, 95% CI [5.30, 6.78], men). Similarly large differences were observed for time in hospital in the year post-diagnosis by emergency diagnosis status. For example, adjusted rate ratios of 8.76 (95% CI [6.52, 11.8]) for men with coeliac disease, and 5.59 (95%CI [2.57, 12.2]) for women diagnosed with Lyme disease. The findings were consistent across two subsets of CPRD data (Aurum, GOLD). Analyses of patients with five supplementary cancer sites (brain, colon, lung, pancreas, and ovary) produced findings concordant with prior literature, supporting the validity of the study methods. The main study limitation is the assumption of accurate recording of diagnoses in health records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Emergency diagnosis is common and associated with worse clinical outcomes in a wide range of conditions with diverse aetiology. Further research and investment to reduce the number of emergency diagnoses is needed, particularly for diseases where diagnosis in community settings should be expected (e.g., rheumatoid arthritis and COPD), and conditions such as coeliac disease, IBD, and MS, where emergency diagnosis is associated with particularly poor outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pmed.1005182","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:21:27Z","timestamp":1787678487000},"page":"e1005182","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1371","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5427-7150","authenticated-orcid":true,"given":"Emma","family":"Whitfield","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0643-7890","authenticated-orcid":true,"given":"Becky","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1148-1922","authenticated-orcid":true,"given":"Matthew 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Investigating physical health and related secondary care use in people with severe mental illness using electronic health records. 2023."},{"key":"pmed.1005182.ref030","doi-asserted-by":"crossref","DOI":"10.1503\/cmaj.190757","article-title":"Development and validation of the Cambridge Multimorbidity Score","volume":"192","author":"RA Payne","year":"2020","journal-title":"CMAJ"},{"key":"pmed.1005182.ref031","author":"National Health Service"},{"key":"pmed.1005182.ref032"},{"key":"pmed.1005182.ref033","volume-title":"R: a language and environment for statistical computing","author":"R Core Team","year":"2021"},{"issue":"43","key":"pmed.1005182.ref034","doi-asserted-by":"crossref","first-page":"1686","DOI":"10.21105\/joss.01686","article-title":"Welcome to the Tidyverse","volume":"4","author":"H Wickham","year":"2019","journal-title":"JOSS"},{"key":"pmed.1005182.ref035","first-page":"7","article-title":"Diagnostic checking in regression relationships","author":"A Zeileis","year":"2002","journal-title":"R News"},{"key":"pmed.1005182.ref036","first-page":"378","article-title":"glmmTMB balances speed and flexibility among packages for zero-inflated generalized linear mixed modeling","volume":"9","author":"ME Brooks","year":"2017","journal-title":"R Journal"},{"key":"pmed.1005182.ref037","author":"E Whitfield","year":"2026"},{"key":"pmed.1005182.ref038","doi-asserted-by":"crossref","first-page":"101574","DOI":"10.1016\/j.canep.2019.101574","article-title":"Population trends in emergency cancer diagnoses: the role of changing patient case-mix","volume":"63","author":"A Herbert","year":"2019","journal-title":"Cancer Epidemiol"},{"issue":"9","key":"pmed.1005182.ref039","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1016\/S2215-0366(22)00225-5","article-title":"The temporal relationship between severe mental illness diagnosis and chronic physical comorbidity: a UK primary care cohort study of disease burden over 10 years","volume":"9","author":"N Launders","year":"2022","journal-title":"Lancet Psychiatry"},{"issue":"1","key":"pmed.1005182.ref040","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1111\/j.1365-2125.2009.03537.x","article-title":"Validation and validity of diagnoses in the General Practice Research Database: a systematic review","volume":"69","author":"E Herrett","year":"2010","journal-title":"Br J Clin Pharmacol"},{"issue":"7","key":"pmed.1005182.ref041","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-005540","article-title":"Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD)","volume":"4","author":"JK Quint","year":"2014","journal-title":"BMJ Open"},{"key":"pmed.1005182.ref042","doi-asserted-by":"crossref","first-page":"107174","DOI":"10.1016\/j.lungcan.2023.03.010","article-title":"Emergency presentation prior to lung cancer diagnosis: a national-level examination of disparities and survival outcomes","volume":"179","author":"J Gurney","year":"2023","journal-title":"Lung Cancer"},{"issue":"1","key":"pmed.1005182.ref043","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s12889-019-6462-5","article-title":"Diagnostic pathways and delay among tuberculosis patients in Stockholm, Sweden: a retrospective observational study","volume":"19","author":"A Wikell","year":"2019","journal-title":"BMC Public Health"},{"key":"pmed.1005182.ref044","author":"National Disease Registration Service"},{"issue":"8","key":"pmed.1005182.ref045","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.1038\/bjc.2012.408","article-title":"Routes to diagnosis for cancer - 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