Patterns of emergency department visits before diagnosis with digestive neuroendocrine neoplasms

Objective: To evaluate the patterns of emergency department visits before diagnosis with digestive neuroendocrine neoplasms (NENs). Methods: Linked administrative databases from the province of Alberta, Canada, were examined, and patients diagnosed with digestive NENs from 2004 to 2019 were reviewed. Incidents of emergency department visits in the 3 months before histological diagnosis were reviewed. Multivariable logistic regression analyses were used to examine factors associated with at least one emergency department (ED) visit as well as factors associated with more than one ED visit. The impact of pre-diagnosis ED visits on overall survival was further assessed in a multivariable Cox regression model, which included (in addition to ED visits), age at diagnosis, sex, histology, Charlson comorbidity index, and stage. Results: A total of 2120 patients were considered eligible for the study, and they were included in the analysis (including 1041 patients (49.1%) with at least one ED visit in the 3 months before diagnosis). The following factors were associated with a higher likelihood of an ED visit prior to diagnosis: younger age (OR with increasing age: 0.983; 95% CI: 0.977–0.989), higher comorbidity index (OR: 1.332; 95% CI: 1.215–1.460), female sex (OR: 1.292; 95% CI: 1.084–1.540), and stage IV (OR: 1.515; 95% CI: 1.106–2.075). Likewise, the following factors were associated with more than one ED visit within 3 months before diagnosis: younger age (OR with increasing age: 0.985; 95% CI: 0.979–0.992), higher comorbidity index (OR: 1.280; 95% CI: 1.167–1.405), and female sex (OR: 1.516; 95% CI: 1.230–1.868). Using multivariable Cox regression modeling, the following factors were associated with worse overall survival (higher risk of death): older age (HR: 1.050; 95% CI: 1.043–1.056), higher comorbidity index (HR: 1.280; 95% CI: 1.209–1.356), stage IV (HR: 3.163; 95% CI: 2.562–3.905), neuroendocrine carcinoma histology (HR: 1.645; 95% CI: 1.350–2.003), pre-diagnosis ED visit (HR: 1.784; 95% CI: 1.529–2.083). Conclusion: Almost one-half of patients with NENs visit the ED within 3 months before diagnosis. ED visits were associated with younger age, female sex, advanced disease, and higher comorbidity. Moreover, pre-diagnosis ED visit(s) were associated with worse overall survival in the current cohort.