Nicholas Pettit, PhD, DO

Indiana University

"The Incidence of Diagnosing Cancer in the Emergency Department"
SAEMF/RAMS Resident Research Grant




The purpose of this study is to investigate the incidence and prevalence of new onset mass/malignancy diagnoses in the emergency department. We will screen for new onset cancer diagnoses and link them to ED visits within the past 12 weeks across a large study population. From here we can determine a preliminary understanding and rate at which cancer is diagnosed, or at least suspected at an initial ED visit.

From query of an administrative database (INPC), we will determine the frequency with which patients with any diagnosis of a specific cancer and visit the ED prior to that diagnosis. We will then investigate the rates of various outcome associated with these visits and subsequent ED visits, such as radiological and laboratory data, risk factors (smoking or alcohol use), BMI, rehospitalization, lengths of stay, survival, admission diagnosis (abdominal pain, shortness of breath, fever, chest pain, vomiting, altered mental status, headache, back pain, critical lab value [neutropenia, hyperkalemia, etc,]) and potential complications related to malignancy or treatment (pulmonary embolism, spinal cord compression.

This project is a retrospective cohort analysis using de-identified information from the INPC database through collaboration with the Regenstrief Institute. All patients with the diagnosis of neoplasm, cancer NOS, or pulmonary nodule within the past 5 years will be included. That population will then be screened down to include people only who had an ED visit in the preceding 12 weeks to determine if that mass/malignancy was discovered in that ED visit. Patient information including ICD-9 or ICD-10 diagnoses, comorbidities, demographics, medications, laboratory work, body mass index, imaging reports, encounters and death/vital status, will be pulled from this database.

Of the estimated 105,000,000 Emergency Department (ED) visits annually, almost 4,000,000 (3.8%) are that of cancer patients. Compared to non-cancer patients, ED patients are older, experience longer ED length of stay, undergo radiological testing (including CT scans), more likely to be septic, have higher thrombosis rates, and are more likely to be admitted to the hospital. Thus, the ED presents as a unique interface for the large number of potentially sick cancer patients. Knowing the impact of cancer-related illnesses is research that is ongoing, but little is known about the rate of new-onset cancer diagnoses in the ED. This is certainly something that happens with regularity in the ED, anecdotally, and by studying how often new diagnoses occur, we can then learn how to most appropriately treat and coordinate the care of this sick and vulnerable population.

Research Results

Dr. Pettit is still completing the project.