---
title: "Emergency diagnosis frequency and outcomes across 13 non-cancer conditions in England: analysis of"
id: "plos-medicine-2-frequency-and-prognostic-outcomes-of-emergency-diagnosis-in-13-non-neoplastic"
canonical_url: "https://medichelpline.com/clinical-feed/plos-medicine-2-frequency-and-prognostic-outcomes-of-emergency-diagnosis-in-13-non-neoplastic"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS Medicine"
source_url: "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182"
published_at: "2026-08-25T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Emergency diagnosis frequency and outcomes across 13 non-cancer conditions in England: analysis of
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-medicine-2-frequency-and-prognostic-outcomes-of-emergency-diagnosis-in-13-non-neoplastic
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS Medicine
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182)
- **Published At:** 2026-08-25T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This population-based cohort study analysed linked primary care, hospital, and death records for 1,701,154 patients in England diagnosed with 13 exemplar non-neoplastic conditions between 1999 and 2019. Key data sources were CPRD (Aurum and GOLD), Hospital Episode Statistics, and Office for National Statistics. - The study measured the proportion of patients whose diagnosis occurred during or soon after emergency hospital care (termed **emergency diagnosis**) and compared 1-year mortality and time spent in hospital after diagnosis between emergency and non-emergency groups. - Emergency diagnosis was common: at least 20% of patients had emergency diagnoses for 9 of 13 conditions. More than 30% of patients with **Parkinson’s disease** and 35% of patients with **COPD** were diagnosed as emergencies. - For 9 of 13 conditions there was a substantial absolute increase (≥10%) in 1-year mortality among patients diagnosed as an emergency versus non-emergency patients. - After adjustment for age, year of diagnosis, deprivation, comorbidity burden, and care setting, emergency diagnosis remained strongly associated with higher 1-year mortality for many conditions, including large adjusted odds ratios for **coeliac disease** (adjusted OR 7.53, 95% CI 5.64–10.1, women) and **inflammatory bowel disease (IBD)** (adjusted OR 5.99, 95% CI 5.30–6.78, men). - Time in hospital in the year after diagnosis was also markedly greater in emergency-diagnosed patients; examples include 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 with Lyme disease. - Findings were consistent across CPRD Aurum and GOLD subsets and were concordant with prior literature when applied to supplementary cancer sites, supporting study validity. - The principal limitation is reliance on the accuracy of recorded diagnoses and diagnosis dates in routine health records, and the emergency diagnosis definition may include patients whose emergency episode was unrelated to the yet-undiagnosed condition. - The authors conclude that **emergency diagnosis** is common across diverse conditions and associated with worse outcomes, and they call for research and investment to reduce emergency diagnoses, especially for conditions expected to be diagnosed in community settings (for example, rheumatoid arthritis and COPD) and for conditions where emergency diagnosis correlates with particularly poor prognosis (coeliac disease, IBD, MS).
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosmedicine%2Farticle%3Fid%3D10.1371%2Fjournal.pmed.1005182) * * About * Browse * Publish * [](https://journals.plos.org/plosmedicine/ "PLOS Medicine") * Search [advanced search](https://journals.plos.org/plosmedicine/search) * 0 [Save](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182#savedHeader) * 0 [Citation](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182#citedHeader) * 57 [View](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182#viewedHeader) * 0 [Share](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182#discussedHeader) Open Access Peer-reviewed Research Article # 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 * Emma Whitfield , Roles Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing * E-mail: emma.whitfield.20@ucl.ac.uk Affiliation ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-5427-7150 ](https://orcid.org/0000-0001-5427-7150 "ORCID Registry") ⨯ * Becky White, Roles Data curation, Methodology, Supervision, Writing – review & editing Affiliation ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-0643-7890 ](https://orcid.org/0000-0002-0643-7890 "ORCID Registry") ⨯ * Matthew E. Barclay, Roles Methodology, Supervision, Writing – review & editing Affiliation ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-1148-1922 ](https://orcid.org/0000-0003-1148-1922 "ORCID Registry") ⨯ * Meena Rafiq, Roles Validation, Writing – review & editing Affiliations ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), London, United Kingdom, Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-1837-1542 ](https://orcid.org/0000-0002-1837-1542 "ORCID Registry") ⨯ * Nadine Zakkak, Roles Data curation, Writing – review & editing Affiliations ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), London, United Kingdom, Cancer Intelligence, Cancer Research UK, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0003-4155-7756 ](https://orcid.org/0000-0003-4155-7756 "ORCID Registry") ⨯ * Marta Berglund, Roles Data curation, Writing – review & editing Affiliation ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0002-3015-3190 ](https://orcid.org/0009-0002-3015-3190 "ORCID Registry") ⨯ * Hardeep Singh, Roles Writing – review & editing Affiliation Safety, Quality & Well-Being Institute, Houston Methodist, Houston, Texas, United States of America ⨯ * Sean McPhail, Roles Writing – review & editing Affiliation National Disease Registration Service, NHS England, Leeds, United Kingdom ⨯ * Spiros Denaxas, Roles Methodology, Supervision, Writing – review & editing Affiliations Institute of Health Informatics, UCL, London, United Kingdom, Interdisciplinary Transformation University, Linz, Austria, Health Data Research UK, London, United Kingdom, UCL Hospitals Biomedical Research Centre, London, United Kingdom, British Heart Foundation Data Science Centre, London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-9612-7791 ](https://orcid.org/0000-0001-9612-7791 "ORCID Registry") ⨯ * Georgios Lyratzopoulos Roles Conceptualization, Methodology, Supervision, Writing – review & editing Affiliation ECHO (Epidemiology of Cancer Healthcare & Outcomes), Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, UCL (University College London), London, United Kingdom [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-2873-7421 ](https://orcid.org/0000-0002-2873-7421 "ORCID Registry") ⨯ # 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 * Emma Whitfield, * Becky White, * Matthew E. Barclay, * Meena Rafiq, * Nadine Zakkak, * Marta Berglund, * Hardeep Singh, * Sean McPhail, … * Spiros Denaxas, * Georgios Lyratzopoulos ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 25, 2026 * * [Article](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182) * [Authors](https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.1005182) * [Metrics](https://journals.plos.org/plosmedicine/article/metrics?id=10.1371/journal.pmed.1005182) * [Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005182) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pmed.1005182) * [Abstract](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#abstract0) * [Author summary](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#abstract1) * [Introduction](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#sec007) * [Methods](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#sec008) * [Results](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#sec019) * [Discussion](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#sec026) * [Supporting information](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#sec027) * [Acknowledgments](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#ack) * [References](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#references) * [Reader Comments](https://journals.plos.org/plosmedicine/article/comments?id=10.1371/journal.pmed.1005182) * [Figures](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182) ## Abstract ### Background In patients with cancer, diagnosis through or soon after the use of emergency hospital care (‘emergency diagnosis’) is associated with advanced disease and poor prognosis. The varied and complex reasons for emergency diagnoses—including rapid disease progression, patient factors, and system delays—are 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. ### Methods and findings 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’s 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’s 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. ### Conclusions 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. ## Author summary ### Why was this study done? * There is growing recognition that improvements are needed to enable patients to be diagnosed with many conditions earlier. * Many patients with cancer are diagnosed as an emergency (the diagnosis is made after the patient receives emergency hospital care) and experience worse outcomes—consequently, substantial efforts have been made to reduce the number of patients diagnosed with cancer as an emergency. * It is unclear if emergency diagnosis is a phenomenon specific to cancer or if it also occurs frequently in other conditions. ### What did the researchers do and find? * We examined health records from ~1.7 million patients in England who were diagnosed with 13 conditions between 1999 and 2019. * Emergency diagnoses were common, with more than one in five patients diagnosed after an emergency presentation in nine conditions. * Patients diagnosed as an emergency were more likely to die and to spend longer in hospital in the year after diagnosis. ### What do these findings mean? * It is unclear why emergency diagnoses happen—further research should consider both general and disease-specific drivers to examine why emergency diagnoses occur across diverse conditions, but at varying frequencies. * Whilst patients diagnosed as an emergency are more likely to have worse outcomes, it is not yet known whether either preventing emergency diagnoses or improving the management of patients diagnosed as an emergency would lead to improved outcomes. * Limitations include the assumption that recording of diagnoses and diagnosis dates are accurate, and that the definition of emergency diagnosis used may identify patients whose emergency care episode was unrelated to their as-yet-undiagnosed condition. ## Figures ![Fig 11](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g011) ![Table 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.t001) ![Fig 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g001) ![Fig 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g002) ![Fig 3](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g003) ![Fig 4](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g004) ![Fig 5](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g005) ![Fig 6](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g006) ![Fig 7](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g007) ![Table 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.t002) ![Fig 8](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g008) ![Table 3](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.t003) ![Fig 9](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g009) ![Table 4](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.t004) ![Fig 10](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g010) ![Table 5](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.t005) ![Fig 11](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g011) ![Table 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.t001) ![Fig 1](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g001) ![Fig 2](https://journals.plos.org/plosmedicine/article/figure/image?size=inline&id=10.1371/journal.pmed.1005182.g002) **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 **Academic Editor:** Jorge Pacheco, Ministry of Health: Gobierno de Chile Ministerio de Salud, CHILE **Received:** January 5, 2026; **Accepted:** July 3, 2026; **Published:** August 25, 2026 This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the [Creative Commons CC0](https://creativecommons.org/publicdomain/zero/1.0/) public domain dedication. **Data Availability:** To guarantee the confidentiality of personal and health information, only the authors had access to the data during the study in accordance with the relevant licence agreement. CPRD linked data were provided under a licence that does not permit sharing. Access to CPRD data and linked data such as Hospital Episode Statistics, is subject to protocol approval via CPRD’s Research Data Governance (RDG) Process: . The minimal dataset, consisting of values used to build graphs, can be found in tables throughout the manuscript, [S1 Appendix](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#pmed.1005182.s002), and [S1 Data](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1005182#pmed.1005182.s004). **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; ). 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; ). 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. **Competing interests:** I have read the journal’s policy and the authors of this manuscript have the following competing interests: HS reported consulting fees from The Leapfrog Group unrelated to this study. MEB reported consulting fees from Cancer Research UK and personal fees from GRAIL Inc. for Independent Data Monitoring Committee (IDMC) membership unrelated to this study. MR reported consulting fees from QIMR Berghofer Medical Research Institute unrelated to this study, honoraria from the Royal College of General Practitioners, support for attending meetings and/or travel from WHO Europe and is the co-chair of the Prevention and Early Diagnosis working group of the Primary Care Collaborative Cancer Clinical Trials Group funded by Cancer Australia. Unrelated to this study and the funding outlined in the Funding Statement, NZ is a Senior Data and Research Analyst at Cancer Research UK, and SD received funding in the past to co-create and co-lead the National Phenotype Library at HDR UK. All other authors have declared that no competing interests exist. **Abbreviations:** APC, Admitted Patient Care; AS, axial spondyloarthritis; CHD, coronary/ischaemic heart disease; COPD
## Related Clinical Research

- [Climate change worsens health for people with chronic illness](https://medichelpline.com/clinical-feed/stat-news-1-opinion-climate-change-is-making-people-with-chronic-illness-even-sicker.md)
- [Bupropion Hydrochloride for Improving Recovery in Acute Ischaemic Stroke: BASE Trial Protocol](https://medichelpline.com/clinical-feed/bmj-open-4-protocol-for-base-a-multicentre-double-blind-randomised-controlled-trial-of.md)
- [ARID5B promotes transition from inflammatory to tissue‑destructive fibroblasts in arthritis](https://medichelpline.com/clinical-feed/biorxiv-1-arid5b-drives-an-inflammatory-to-destructive-shift-in-pathologic-fibroblast.md)
- [CAR-T cell therapy in autoimmune diseases: progress, challenges, and emerging technologies](https://medichelpline.com/clinical-feed/plos-medicine-0-progress-and-promise-of-car-t-cell-treatment-in-autoimmune-diseases.md)
- [Causal CD40 Allele (rs1883832) Reveals Context-Specific Trans-Effects in B Cells](https://medichelpline.com/clinical-feed/biorxiv-0-identifying-the-causal-allele-in-the-cd40-autoimmune-locus-enables-discovery-of.md)

## Navigation
- [← Back to General Feed](https://medichelpline.com/clinical-feed/general.md)
- [← All Clinical Specialties](https://medichelpline.com/clinical-feed.md)
## Medical & Regulatory Disclaimer

> [!CAUTION]
> MedicHelpline content is structured for research, educational, and professional discovery purposes. It does not constitute individual medical advice, clinical diagnosis, or treatment recommendations.
> Always verify dosing, contraindications, and regulatory alerts against official product labeling and primary regulatory sources before clinical decision-making.