Emergency Department Presentation Research Articles

Health impacts of the 2019–2020 Australian “Black Summer” bushfires: smoke-related asthma emergency department presentations in New South Wales and the Australian Capital Territory

ABSTRACT Bushfires contribute to environmental pollution in the form of Particulate Matter (PM). PM with an aerodynamic diameter of ≤ 2.5 μm (PM2.5) is relevant to individuals with chronic respiratory diseases such as asthma. These particles tend to enter the bloodstream and activate inflammatory processes, leading to asthma exacerbation. This study examines this environmental-health relationship in the context of the 2019–2020 “Black Summer” bushfires in New South Wales (NSW) and the Australian Capital Territory (ACT) regions of Australia. Weekly measurements of emergency department (ED) presentations for asthma from 1 September 2019 to 29 February 2020 were collected and compared to weekly averages of PM2.5, meteorological data, and other relevant covariables. To control for seasonal changes in ED presentations unrelated to bushfire smoke, the observed PM2.5 values and ED presentations were subtracted from corresponding values the year prior. A quasi-Poisson generalised linear model (GLM) was used to assess the impact of PM2.5 and these covariables on weekly ED presentations for asthma. The model explained approximately 33% of the variance in asthma presentations with PM2.5, minimum temperature and relative humidity being the most significant covariables. These findings provide insight into this environmental-health relationship and support public health planning for smoke-related asthma presentations.

Psychiatric Emergency Service Use by Transgender and Gender-Diverse Youth.

To document the proportion of transgender and gender diverse (TGD) youth presenting to a pediatric psychiatric emergency department (ED) and examine whether their demographic and clinical characteristics differ from cisgender youth. We analyzed electronic health records of youth ages 5 to 17 years presenting to a specialized pediatric psychiatric ED (N = 2728), including sociodemographic characteristics, gender identity, suicidal risk at admission, and diagnoses at discharge. We examined differences by gender identity using χ2 tests (categorical variables), 2-sample t tests, or Mann-Whitney U tests (continuous variables). Adjusted Poisson regression models estimated the prevalence ratio of the association between gender identity and clinical diagnoses. Of youth, 6% seeking emergency psychiatric care identified as TGD. Compared with cisgender peers, TGD youth exhibited a higher risk for suicide, longer hospital stays, and received more psychiatric diagnoses at discharge, including a higher prevalence of suicidal thoughts and behaviors (prevalence ratio: 1.50, 95% CI: 1.16, 1.90). TGD youth have more severe clinical presentations in the psychiatric ED compared with cisgender youth. Further research is essential to develop targeted interventions to support the mental health of TGD youth.

Alcohol Related Acute Presentations in Emergency Department of a tertiary care center in Nepal

Introduction: The harmful use of alcohol is a causal factor in many disease andinjury conditions. A causal relationship exists between harmful use of alcoholand a range of mental and behavioral disorders, other noncommunicableconditions and injuries. Alcohol consumption is one of the most commoncauses of visit to the emergency department in different hospitals across Nepal.This study aims to identify the proportion and characteristics of different alcoholrelated acute presentations in the emergency department. Method: A descriptive cross-sectional study was conducted among the patientsaged 18 years or more presenting to Emergency Department of BPKIHS duringthe period of 1 year from 7th February 2018 to 6th February 2019. Purposivesampling was done. Informed and written consent was taken from the patientsfollowed by interviews and questionnaires. Data analysis was done using SPSSversion 24.0. Result: A total of 700 patients were included in the study of which 75.3% were maleand 24.7% female. Most of the patients with alcohol related acute presentationwere from the age group of 20-64 years, with vast majority comprising fromworking population. A total of 43.7% cases were labeled Medico-legal. 44.6%cases were trauma-related. Road Traffic Accident and Physical assault beingthe most common among them, followed by fall from height. 55.4% caseswere non- trauma related; pain abdomen was the most common presentingcomplaint. Among the studied cases, 35.1 % were consuming other substancesalong with alcohol and smoking was most common. 74.9% cases weredischarged after primary treatment and 23.7% cases were admitted to differentdepartments of BPKIHS for needful management. Conclusion: More than 91% of cases evaluated has hazardous drinking patternand mean AUDIT score is 12.35. These huge figures are alarming enough toplan and implement alcohol production, distribution and safe consumptionguideline at local and national level. Further study is needed to explore realburden of alcohol in society.

Imaging of acute small bowel pathologies in oncology patients in the ER part I: the role of Computed Tomography (CT) for the evaluation of Tumor and infections.

Acute abdominal complaints constitute up to 40% of all emergency department (ED) presentations in oncology patients due to a multitude of causes. Small bowel pathologies present a diagnostic challenge due to their diverse range and frequently overlapping clinical presentation. In oncology patients, structural changes resulting from tumor growth, surgery and treatment effects can further complicate the diagnostic process. Due to a weakened immune system, oncology patients are also highly susceptible to infections of the gastrointestinal tract (GIT). Traditional computed tomography (CT) scans are used as the gold standard diagnostic modality. However, three-dimensional (3D) postprocessing techniques including maximal intensity projection (MIP), volume rendering (VR) and cinematic rendering (CR) have been employed to aid image evaluation. For a balanced and organized approach to describe diagnostic challenges in this complex population, we have divided the pictorial essay into two parts. The first part focuses on tumor- and infection-associated causes, as summarized below in the visual abstract. The second part will address treatment-related complications, including chemotherapy, radiotherapy, immunotherapy, graft-versus-host disease and post-surgical complications.

Pediatric Respiratory Score in the Triage Form.

Pediatric Respiratory Score in the Triage Form.

The effects of recreational cannabis legalization in Alberta on poison control centre calls and paediatric emergency department visits

Abstract Objectives To characterize cannabis-related presentations to the two major paediatric emergency departments (EDs) in Alberta as well as calls to Alberta’s Poison and Drug Information Services (PADIS) and detect any changes in relation to legalization. Methods This was a retrospective medical record review analyzing all paediatric (ages 0 to 18) ED presentations for cannabis-related concerns. The two sites included were the Stollery Children’s Hospital in Edmonton and the Alberta Children’s Hospital in Calgary. We searched the PADIS database for all calls in the province for ‘Cannabinoids and Analogues’ for ages 0 to 19. The rates prior to and after legalization were compared. Results While we saw no overall difference in ED visits, pre- and post-legislation we found an increase in unintentional overdoses in children under 12 years of age (7% versus 15%, proportion change 1.13). The severity of presentations did not change during this time period (37% versus 42%, P 0.254). We also found an increase in calls to PADIS in the 2 years after legalization. There was an increase in exposure to edible cannabis formulations during this time period. Conclusion This study combines a province-wide medical record review of ED visits with poison control centre information to provide a complete look at cannabis intoxication in paediatric patients over the time of legalization. It adds to the growing body of evidence that legalization of recreational cannabis, especially edible formulations has resulted in increased unintentional overdoses in young children.

A retrospective medical record audit of the management of cannabis-related emergency department presentations, hospital admissions and hyperemesis of pregnant women who self-reported non-medicinal cannabis use to a substance use in parenting and pregnancy service.

Research on cannabis-related hyperemesis and its identification and management during pregnancy is scarce. This study aimed to investigate the management of cannabis-related emergency department (ED) presentations, hospital admissions and hyperemesis of pregnant women who self-reported non-medicinal cannabis use to a substance use in pregnancy and parenting service (SUPPS). A retrospective medical record audit was conducted on 75 SUPPS patients who identified cannabis as their primary drug of concern and gave birth between January 2015 and May 2020 in Australia. Their ED presentations and hospital admissions in the 12 months prior to the baby's delivery were examined. A descriptive analysis was conducted. The patients had 232 ED presentations and 183 hospital admissions. History of cannabis use was identified and documented in 34% of the ED presentations and 53% of the hospital admissions. Screening of current substance use was conducted in 45% of the ED presentations and 53% of the hospital admissions. Withdrawal symptoms were documented in 3% of the ED presentations and 13% of the hospital admissions. Cannabis use status was asked in 36% of the ED presentations and 52% of the hospital admissions. Take home medications were provided in 12% of the ED presentations and 12% of the hospital admissions. Referral to SUPPS was made in 7% of the hospital admissions, but none from ED. Gaps in the management of cannabis-related ED presentations and hospital admissions were identified. Routine substance use screening should be conducted to enable early identification of cannabis use during pregnancy.

Severity Indices of Diquat Poisoning for Triage and Prognosis in Acute Diquat Poisoning: A Multicenter Prospective Cohort Study.

Severity Indices of Diquat Poisoning for Triage and Prognosis in Acute Diquat Poisoning: A Multicenter Prospective Cohort Study.

Association of Early Noninvasive Cardiac Stress Testing With Acute Myocardial Infarction and Mortality.

Association of Early Noninvasive Cardiac Stress Testing With Acute Myocardial Infarction and Mortality.

Interventions for self-harm and suicidality in paediatric emergency departments: a meta-review

Abstract Paediatric emergency department (ED) presentations for self-harm and suicidality have significantly increased worldwide in the past decade, making paediatric EDs a key point of contact for young people experiencing suicidal ideation. Since 2022, four systematic reviews have been conducted on interventions for self-harm/suicidality in paediatric EDs, but findings were limited by small sample sizes and high heterogeneity. This meta-review provides recommendations to guide clinical practice and future research to enhance the quality of interventions in paediatric EDs for addressing self-harm and suicide related behaviours. Of 286 studies identified, five reviews synthesising 14 individual studies on ED-based interventions published up to May 2022 were included. Key themes and conclusions were synthesised. Three main themes emerged including: lack of informative trials, low levels of intervention effectiveness and common intervention elements. Informativeness of prior trials was limited by small sample sizes, lack of globally relevant research and limited stakeholder perspectives. Common intervention elements included: follow-up contact post-ED discharge, family involvement and psychoeducation with safety planning. Limited progress has been made in this field, likely due to challenges in conducting rigorous trials in paediatric EDs. Research has failed to incorporate voices of young people and their families, crucial for meeting their needs. Future research must prioritise co-design with youth, parents, and stakeholders as a critical next step in developing more effective paediatric ED interventions. Digital tools may offer promise for delivering interventions in the ED but should complement face-to-face professional contact.

Triaging Acute Chest Syndrome Clinical Decision-Making Using Bedside SaO2/FiO2 Ratio

Acute chest syndrome (ACS) severity is inconsistently defined and its clinical course difficult to predict. This retrospective observational study evaluated the utility of the ratio of the pulse oximetry oxygen saturation to the fraction of inspired oxygen (SaO2/FiO2) in adult patients with ACS and its association with the clinical outcome of intensive care unit (ICU) transfer. Across all ACS hospitalizations at a tertiary medical center from 2017-2021, we characterized the SaO2/FiO2 ratio at 3 timepoints: emergency department (ED) presentation, diagnosis with ACS, and antibiotic initiation. Of the 227 hospitalizations identified, 54% were female, mean age was 29, 70% had Hgb SS, and 9% had obesity. While ICU transfer was not strongly associated with the SaO2/FiO2 ratio at ED presentation (AUC 0.59), it was strongly associated with the SaO2/FiO2 ratio at ACS diagnosis (AUC 0.73) and antibiotic initiation (AUC 0.74). Given the highest sensitivity at ACS diagnosis, a diagnostic SaO2/FiO2 cutoff of 310 was proposed for triaging likely ICU transfer (sensitivity 63%, specificity 82%, aOR 8.94, 95% CI 2.12-37.6, adjusted HR 4.86, 95% CI 1.91-12.4) with models adjusting for obesity, lung disease, and blood counts. This cutoff corresponds to an SpO2 below 90% on 2 L/min nasal cannula support. We propose using the SaO2/FiO2 ratio cutoff of 310 prospectively as a simple bedside triage tool for adult patients with sickle cell disease hospitalized with ACS to be transferred to a higher level of care.

Perfusion index as a surrogate for lactate clearance as resuscitation endpoint in sepsis

Background Sepsis Remains one of the most common presentations in emergency departments. Fluid resuscitation is one pillar of management strategy. The perfusion index (PI), can be a valid surrogate for lactate clearance in this prospect. Aim To investigate the ability of the PerfuIndex as a novel, bedside, noninvasive resuscitation endpoint in sepsis patients. Patients and methods Our team designed a prospective observational study including a patient sample aged greater than or equal to 18 of both sexes, with clinically suspected sepsis. Participants underwent a categorization into two groups: group A resuscitated and group B nonresuscitated. Statistical analysis of observed changes in PI readings was conducted to estimate a correlation between both measurements, Lactate Clearance and delta PI. Results Cases underwent a categorization into two groups, group A (resuscitated, n=28) and group B (nonresuscitated, n=22). Serum lactate showed a significant reduction within the resuscitated group as opposed to the nonresuscitated group at 0 min and 120 min (P<0.001). PI was significantly higher in the resuscitated group at 60, 90, and 120 min (P<0.05). Delta-1 PI (0–60 min), and delta 2 PI (0–120 min) showed a significant elevation within the resuscitated group (P=0.003 and <0.001). A positive association was documented between lactate clearance as well as delta 2 PI (P <0.001). Delta 2 of PI can significantly predict fluid resuscitation in sepsis patients at a cut-off greater than 1.41 Conclusions PI could stand as a valid surrogate marker for evaluating the fluid resuscitation effectiveness in sepsis patients, potentially complementing, or even replacing more invasive monitoring techniques.

Association of Clinical Indicators of Acute Deterioration and Morbidity and Mortality in the Residential Aged Care Population: A Retrospective Cohort Study of Routinely Collected Health Data.

The timely identification of acute deterioration in people living in residential aged care is critical to reducing rates of resident morbidity and mortality. However, residents often present with atypical or nonspecific presentations that make this difficult. This study aimed to quantify the strength of the relationship between the indicators acute deterioration reported in the literature and morbidity and mortality. A retrospective cohort study using routinely collected health data. A single dependant acute deterioration variable (emergency department presentation or hospital admission or death within 7 days of the last completed international resident assessment instrument long-term care facility (interRAI-LTCF) assessment) was correlated with indicators of acute deterioration reported in the literature and available in interRAI-LTCF. Univariate and multivariate logistic regression analysis evaluated this association. Nine variables were independently associated with acute deterioration. These were being 'largely asleep or unresponsive' odds ratio (OR): 7.95, 95% CI: 4.72-13.39, p < 0.001, 'easily distracted' (OR: 1.78, 95% CI: 1.28-2.49, p < 0.001), eating 'one or fewer meals a day' (OR: 2.13, 95% CI: 1.67-2.73, p < 0.001), reduced activities of daily living (OR: 2.06, 95% CI: 1.11-3.82, p = 0.02) inability to complete toilet transfer (OR: 1.95, 95% CI: 1.24-3.03, p = 0.004), 'dyspnoea; at rest' (OR: 1.81, 95% CI: 1.32-2.49, p < 0.001), 'two or more falls in 30 days' (OR: 1.53, 95% CI: 1.15-2.03, p = 0.003), peripheral oedema (OR: 1.37, 95 CI: 1.07-1.77, p = 0.014) and daily pain (OR: 1.37, 95% CI: 1.05-1.77, p = 0.019). Presenting with one of nine variables made residents between 1.4 and 8 times more likely to be experiencing acute deterioration than others living in the facility. The monitoring the resident for these variables by healthcare assistants could support the timely identification of acute deterioration. Not applicable.

Emergency department presentations by trans and gender diverse people in Sydney, Australia: Retrospective case series.

Comprehensively describe patient and presentation characteristics of trans and gender diverse (TGD) people attending the ED. Retrospective case series that evaluated TGD people of all ages presenting to a tertiary, inner-city ED in Sydney, New South Wales, over a 5-year period. TGD people were identified using the ED patient tracking system, triage text and clinical notes in the electronic medical records (eMR). Patient and presentation data were extracted and descriptively analysed, including clinical characteristics, mismatches in registered gender and name, and use of non-affirming language in discharge letters. A total of 340 TGD patients with 1519 ED presentations were identified. The number of ED presentations per year by TGD people increased by 74.2% over 5 years. Presentations were prioritised Australasian Triage Scale category 1-3 in 76.7%. Hospital admission was required in 25.5%, and 8.7% left prior to treatment completion. Suicidal ideation was the most common presenting problem (13.8%) and mental health was the most common ED diagnostic category (29.4%). The gender and name registered in the eMR correctly matched the patient's current identity in 47.1% and 56.8%, respectively. Misgendering and/or deadnaming occurred in 22.6% of those receiving an ED discharge letter. Most TGD people identified by the present study had high acuity ED presentations, often presenting with acute mental health problems, and one-quarter were subsequently admitted to hospital. Mismatched patient details and misgendering and/or deadnaming on discharge letters were common. These findings highlight clear opportunities to improve the care of TGD people in the ED.

Severe Outcomes From Suspected Human Parvovirus B19 Infection in Immunocompetent Children: The Need for Timely Recognition.

We reported a cluster of 13 previously healthy children who, over a short time frame, received care at a Level III Pediatric Hospital following emergency department (ED) presentations with severe outcomes from suspected human Parvovirus B19 (PVB19) infection, and the presence of PVB19 viremia at presentation. Among these patients, we identified seven cases of myocarditis, one case of acute anterior myocardial infarction due to coronary aneurysms secondary to Kawasaki disease, one case of severe anemia with pancytopenia, two cases of encephalitis, one case of septic shock with meningitis, and one case of septic shock with pancreatitis. Four children required ECMO treatment. One patient succumbed to cardiac shock, while two patients were assisted by the Berlin Heart Support System and remain on the transplant list. After discharge, all patients required ongoing medical assistance, including follow-up care or therapy. This report underscores the importance of prioritizing proactive surveillance by health professionals, focusing not only on monitoring emerging pathogens but also on those that may reemerge with increased aggressiveness in the epidemiological landscape. Additionally, it highlights the need to reassess the risk of severe PVB19 infections in healthy populations.

Ambulance Service Utilization by Kidney Transplant Recipients.

Compared with the general population, kidney transplant recipients (KTRs) frequently visit the emergency department (ED), but much less is known about the characteristics of ED presentations requiring ambulance transport and the impact on subsequent outcomes for KTRs. To identify predictors of ambulance transport to the ED (ambulance-ED) and outcomes (graft failure and mortality) for those who experienced an ambulance-ED event in a cohort of KTRs. Retrospective cohort study of incident, adult KTRs receiving a transplant from 2008 to 2020. Nova Scotia, Canada. Adult (≥18 years), Nova Scotian KTRs affiliated with the Atlantic Canada Multi-Organ Transplant Program. Ambulance-ED events were captured for all transplant recipients (following the day of discharge from their initial transplant admission) using electronic records (provided by Emergency Health Services, the sole provider of emergency medical services for Nova Scotia). Ambulance-ED was defined as ambulance transport to the ED following a 911 call; interfacility transfers were excluded. Predictors of ambulance-ED included recipient, donor, immunological, and perioperative characteristics (pertaining to the initial admission for kidney transplantation). Outcomes included graft failure and mortality. Predictors of ambulance-ED were analyzed using a multivariable negative binomial regression model and reported using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). The risk of death/graft failure for those with an ambulance-ED within 30 days of hospital discharge following transplantation was analyzed using an adjusted Cox survival analysis and reported using hazard ratios (HRs) and 95% CIs. A total of 418 patients received a transplant during the study period. A total of 179 (42.8%) experienced one or more ambulance-ED events. Female sex (IRR = 1.60; 95% CI = 1.12-2.29), kidney failure secondary to diabetes (IRR = 2.52; 95% CI = 1.19-5.31), and donor age ≥45 (IRR = 1.50; 95% CI = 1.04-2.15) were all associated with ambulance-ED. There was no significant increase in the risk of death/graft failure for those that experienced ambulance-ED within 30 days of hospital discharge following transplantation (HR = 1.31; 95% CI = 0.44-3.94). A limitation of this study was that ambulance-ED is not a perfect surrogate marker of acute care needs in a population. Important determinants of health such as living situation and socioeconomic status were not available in this data set. This study highlights the burden of ambulance use for KTRs and provides insight into the need for more optimal follow-up in certain patient subgroups who are at particularly high risk.

Feasibility of Telephone-Based Cognitive Assessments and Healthcare Utilization in US Medicare-Enrolled Older Adults Following Emergency Department Discharge.

Wider screening and assessment for Alzheimer's disease and other related dementias (ADRD) may increase access to supportive care, improve allocation of medical care, and foster the use of interventions that prevent or delay disease progression. Yet, the effect of diagnostic timing on clinical and utilization outcomes is poorly understood. Community-based settings such as a hospital emergency department (ED) may be an underrecognized opportunity to assess cognition and impacts on individuals and health systems. This study assessed the feasibility of recruiting older adults for telephone-based trials following presentation to the ED and administering telephone based cognitive assessments over the phone in this population. Medicare-enrolled individuals 65+ years of age (n=160) presenting to the Oregon Health & Science University Emergency Department (Portland, Oregon) between May 2022 and February 2023 were recruited by telephone. Participants were administered the Telephone Interview for Cognitive Status (TICS) Assessment and the Patient Reported Outcomes Measurement Information System (PROMIS) Cognitive Measure Questions on Mental Clarity via telephone 1-12weeks post-discharge to evaluate cognition. Electronic medical records (EMR) were reviewed for medical care utilization including primary care provider (PCP) visits, hospital admissions, and ED visits for the 3years prior to ED presentation. Twenty-six percent of eligible ED users contacted elected for study enrollment. The TICS Assessment score had a significant relationship with the three evaluated health care utilization measures (ED, PCP visits, or hospitalizations); the PROMIS Assessment had significant but weak correlations to ED and PCP visits. Older adults 65+ years presenting to the ED are amenable to enroll in telephone-based cognition-focused trials and cognitive assessments can be carried out over the telephone in this population. The PROMIS Assessment may be a better cognition assessment tool when evaluating for cognition and care utilization in this population. In addition to the limits of the screening tools used in this study, a lack of a representative sample is a limitation of the study design. Future studies could use other validated cognitive assessment tools and utilize a study design with a recruitment strategy focused on obtaining a representative sample of older ED patients.

The influence of air pollutants on the risk of emergency department presentations of infants with bronchiolitis in an European air quality hotspot.

Acute bronchiolitis is the leading cause of hospitalization in infants, and air pollutants represent a risk factor for its development. This work aims to investigate the role of air pollution, considering conventional and nonconventional indicators, in the development of bronchiolitis in three urban areas in the Po Valley, Northern Italy. This multicentric, observational, retrospective, cohort study included infants under 12 months who were referred to the Pediatric Emergency Department of Bologna, Belluno, and Biella and diagnosed with bronchiolitis from 2016 to 2019. Data on daily ground-level mass concentrations of particulate matter (PM10 and PM2.5) and gaseous pollutants in the three areas, and additionally of organic carbon (OC) and elemental carbon (EC) in Bologna, were retrieved and assessed for possible relationships with the occurrence of bronchiolitis. A total of 1316 patients were enrolled. All conventional air quality indicators (NO2, PM10, and PM2.5) showed statistically significant associations with the occurrence of referrals due to bronchiolitis. The highest impacts were observed for OC and EC, the carbonaceous components of PM, which were only measured in Bologna. Considering the conventional indicators, the strongest associations were found between 4-week moving average concentrations and weekly hospital admission, and the strongest associations were found considering NO2 and PM2.5. This study indicates that medium-term exposure to higher levels of air pollution increases the risk of the development of bronchiolitis. In particular, the best association results between bronchiolitis admissions and the exposure to the carbonaceous fraction of PM2.5.

Geospatial mapping of emergency department presentations in New South Wales Australia (2015 and 2021): Trends in rural and metropolitan areas-A data linkage study.

To examine the relationship between the frequency of presentations to EDs among metropolitan, regional and rural areas in New South Wales (NSW). Retrospective geospatial data linkage cohort study; analysis of total ED presentation rates based on statistical area level 2 (SA2), a standardised geographic unit defined by the Australian Bureau of Statistics (ABS) to represent populations that interact socio-economically. The participants were patients presenting to NSW hospital EDs in 2015 and 2021, based on all hospitals included in the NSW ED Data Collection (EDDC). The main outcomes measured were the relationships at the SA2 level between total ED presentation rates (counting all presentations), total number of different patients who presented at least once per calendar year, and the ratio of total presenters to unique individual presenters (as a marker of repeated presentations). Total presentations to ED per 10 000 population in metropolitan areas decreased by 0.4% (12/2813). In inner regional Australia, there was instead a 10.6% (535/5051) increase. In outer regional Australia, there was a 20.7% (1189/5747) increase. In remote Australia and very remote Australia, ED presentations per 10 000 population increased by 94.6% (5989/6331). Changes were consistent geospatially, demonstrating large increases in presentations in rural and regional areas, but almost no change in metropolitan areas. There was an increase in total ED presentation rates in regional and remote areas between 2015 and 2021, while metropolitan areas saw a slight decrease in presentation rates. Further analysis should be conducted to determine the cause of this increase.

Post-diagnosis Emergency Department Presentation and Demographic Factors in Malignant Skin Cancers: A Data-linkage Cohort Study

Post-diagnosis Emergency Department Presentation and Demographic Factors in Malignant Skin Cancers: A Data-linkage Cohort Study