People diagnosed with Parkinson’s after emergency hospital care had poorer outcomes than those diagnosed through non-emergency routes, a study found.
More than 30 per cent of people with Parkinson’s in the analysis received their diagnosis following an emergency presentation.
Across most conditions studied, emergency diagnosis was associated with higher mortality and longer hospital stays during the following year.
“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,” said first author Emma Whitfield.
“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.”
Researchers at University College London analysed linked primary care, hospital and mortality records from England covering 1.7m patients diagnosed with one of 13 conditions between 1999 and 2019.
The conditions included Parkinson’s disease, multiple sclerosis, schizophrenia, chronic obstructive pulmonary disease, inflammatory bowel disease, rheumatoid arthritis and coeliac disease.
More than one in five patients were diagnosed following an emergency presentation in nine of the 13 conditions examined. The proportion was more than 30 per cent among people with Parkinson’s and 35 per cent among those with chronic obstructive pulmonary disease.
After accounting for factors including age, year of diagnosis, socioeconomic deprivation, other health conditions and healthcare setting, emergency diagnosis remained strongly associated with an increased risk of death within one year.
The association was also seen in conditions that generally have a favourable prognosis, including coeliac disease and inflammatory bowel disease.
Researchers said further work is needed to understand the disease-specific and wider health system factors contributing to emergency diagnosis, and whether reducing emergency diagnoses or improving care for patients diagnosed through emergency pathways could improve outcomes.
Senior author Georgios Lyratzopoulos 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.”
