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The phrase "at first presentation" is correct and usable in written English.
You can use it to refer to the first instance or instance of something being presented or revealed. For example, "At first presentation, the new policy seemed complicated and overwhelming, but after further explanation, it was much easier to understand."
Exact(60)
The most common presenting symptom at first presentation was poor vision (66.4%).
The age at first presentation was 65 ± 16 years, and diabetes was present in eight patients (22%).
Only a relatively small percentage of individuals, those presenting with acute cholecystitis, would normally undergo emergency cholecystectomy at first presentation.
Thus, gluconeogenesis disorders may be difficult to distinguish from glycogen storage disorders at first presentation.
Asymptomatic forearms and wrists in Essex-Lopresti lesions at first presentation have been encountered [22, 29].
Currently, tumor grade is the best predictor of outcome at first presentation of noninvasive papillary (Ta) bladder cancer.
Splenomegaly, thrombocytopenia, anaemia and bone pain were reported as the most common medical problems at first presentation in both surveys.
Radial pulse was absent at first presentation in four patients, and radial nerve injury was documented in six patients.
Right hemihepatectomy with tumor thrombectomy was considered a highly detrimental procedure for this particular patient at first presentation.
It is possible that had this been performed at first presentation, a different outcome would have been encountered here.
As his LBP at first presentation was not so severe, he was treated by immobilization with a soft trunk brace.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com