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No studies have investigated and quantified the extent of clinical variation in hospital admission following an ED presentation for LBP.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We used routinely collected ED data from public hospitals within the state of New South Wales, Australia, to identify presentations of patients aged between 18 and 111 with a discharge diagnosis of LBP. We fitted a series of random effects multilevel logistic regression models adjusted by case-mix and hospital variables. The main outcome was the hospital-adjusted admission rate (HAAR). Data were presented as funnel plots with 95% and 99.8% confidence limits. Hospitals with a HAAR outside the 95% confidence limit were considered to have a HAAR significantly different to the state average.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We identified 176,729 LBP presentations across 177 public hospital EDs and 44,549 hospital admissions (25.2%). The mean (SD) age was 51.8 (19.5) and 52% were female. Hospital factors explained 10% of the variation (ICC\u2009=\u20090.10), and the median odds ratio (MOR) was 2.03. We identified marked variation across hospitals, with HAAR ranging from 6.9 to 65.9%. After adjusting for hospital variables, there was still marked variation between hospitals with similar characteristics.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>We found substantial variation in hospital admissions following a presentation to the ED due to LBP even after controlling by case-mix and hospital characteristics. Given the substantial costs associated with these admissions, our findings indicate the need to investigate sources of variation and to determine instances where the observed variation is warranted or unwarranted.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-022-08134-8","type":"journal-article","created":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T23:02:22Z","timestamp":1657580542000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Hospital variation in admissions for low back pain following an emergency department presentation: a retrospective study"],"prefix":"10.1186","volume":"22","author":[{"given":"Giovanni","family":"Ferreira","sequence":"first","affiliation":[]},{"given":"Marina","family":"Lobo","sequence":"additional","affiliation":[]},{"given":"Bethan","family":"Richards","sequence":"additional","affiliation":[]},{"given":"Michael","family":"Dinh","sequence":"additional","affiliation":[]},{"given":"Chris","family":"Maher","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2022,7,12]]},"reference":[{"issue":"1","key":"8134_CR1","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1186\/s12891-017-1511-7","volume":"18","author":"J Edwards","year":"2017","unstructured":"Edwards J, Hayden J, Asbridge M, Gregoire B, Magee K. 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Following the New South Wales Ministry of Health guideline, The University of Sydney Human Research Ethics Committee exempted this study from ethics approval because (i) it did not identify individuals, (ii) data were not easily re-identifiable and (iii) data were not part of a linkage study. All methods were performed in accordance with the relevant guidelines and regulations as per the New South Wales Ministry of Health recommendations on the use of de-identified data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"835"}}