000075816 001__ 75816 000075816 005__ 20200117212653.0 000075816 0247_ $$2doi$$a10.1371/journal.pone.0203556 000075816 0248_ $$2sideral$$a108523 000075816 037__ $$aART-2018-108523 000075816 041__ $$aeng 000075816 100__ $$aEsteva, M. 000075816 245__ $$aEmergency presentation of colorectal patients in Spain 000075816 260__ $$c2018 000075816 5060_ $$aAccess copy available to the general public$$fUnrestricted 000075816 5203_ $$aBackground Colorectal cancer (CRC) is the leading cause of cancer deaths in Europe. Survival is poorer in patients admitted to hospitals through the emergency department than in electively admitted patients. Knowledge of factors associated with a cancer diagnosis through presentation at an emergency department may reduce the likelihood of an emergency diagnosis. This study evaluated factors influencing the diagnosis of CRC in the emergency department. Methods and findings This is a cross-sectional study in 5 Spanish regions; subjects were incident cases of CRC diagnosed in 9 public hospitals, between 2006 and 2008. Data were obtained from patient interviews and primary care and hospital clinical records. We found that approximately 40% of CRC patients first contacted a hospital for CRC through an emergency service. Women were more likely than men to be emergency presenters. The type of symptom associated with emergency presentation differed between patients with colon cancer and those with rectal cancer, in that the frequency of "alarm symptoms" was significantly lower in colon than in rectal cancer patients who initially presented to emergency services. Soon after symptom onset, some patients went to a hospital emergency service, whereas others contacted their GP. Lack of contact with a GP for CRC-related symptoms was consistently related to emergency presentation. Among patients who contacted a GP, a higher number of consultations for CRC symptoms and any referral to outpatient consultations reduced the likelihood of emergency presentation. All diagnostic time intervals were shorter in emergency presenters than in elective patients. Conclusions Emergency presenters are not a uniform category and can be divided into categories according to their symptoms, help seeking behavior trajectory and interaction with their GPs. Time constraints for testing and delays in obtaining outpatient appointments led patients to visit a hospital service either on their own or after referral by their GP. 000075816 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/PI050700$$9info:eu-repo/grantAgreement/ES/ISCIII/PI050787$$9info:eu-repo/grantAgreement/ES/ISCIII/PI052141$$9info:eu-repo/grantAgreement/ES/ISCIII/PI052273$$9info:eu-repo/grantAgreement/ES/ISCIII/PI052692$$9info:eu-repo/grantAgreement/ES/ISCIII-RETCI/RD12-0005-0011$$9info:eu-repo/grantAgreement/ES/ISCIII-RETCI/G03-170$$9info:eu-repo/grantAgreement/ES/ISCIII/RETICS-RD06-0018 000075816 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttp://creativecommons.org/licenses/by/3.0/es/ 000075816 590__ $$a2.776$$b2018 000075816 591__ $$aMULTIDISCIPLINARY SCIENCES$$b23 / 69 = 0.333$$c2018$$dQ2$$eT2 000075816 592__ $$a1.1$$b2018 000075816 593__ $$aAgricultural and Biological Sciences (miscellaneous)$$c2018$$dQ1 000075816 593__ $$aMedicine (miscellaneous)$$c2018$$dQ1 000075816 593__ $$aBiochemistry, Genetics and Molecular Biology (miscellaneous)$$c2018$$dQ1 000075816 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000075816 700__ $$0(orcid)0000-0002-8153-1473$$a[Ruidíaz], M.$$uUniversidad de Zaragoza 000075816 700__ $$0(orcid)0000-0001-8756-114X$$aSanchez, M.A.$$uUniversidad de Zaragoza 000075816 700__ $$aPertega, S. 000075816 700__ $$aPita-Fernandez, S. 000075816 700__ $$aMacia, F. 000075816 700__ $$aPosso, M. 000075816 700__ $$aGonzalez-Lujan, L. 000075816 700__ $$aBosca-Wats, M.M. 000075816 700__ $$aLeiva, A. 000075816 700__ $$aRipoll, J. 000075816 7102_ $$11006$$2255$$aUniversidad de Zaragoza$$bDpto. Fisiatría y Enfermería$$cÁrea Enfermería 000075816 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina 000075816 773__ $$g13, 10 (2018), e0203556[14 pp]$$pPLoS One$$tPloS one$$x1932-6203 000075816 8564_ $$s379001$$uhttps://zaguan.unizar.es/record/75816/files/texto_completo.pdf$$yVersión publicada 000075816 8564_ $$s107553$$uhttps://zaguan.unizar.es/record/75816/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000075816 909CO $$ooai:zaguan.unizar.es:75816$$particulos$$pdriver 000075816 951__ $$a2020-01-17-21:21:53 000075816 980__ $$aARTICLE