Institute for Musculoskeletal Health, Sydney Local Health District, Sydney, Australia.
School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
BMC Health Serv Res. 2022 Jul 12;22(1):835. doi: 10.1186/s12913-022-08134-8.
One in 6 patients with low back pain (LBP) presenting to emergency departments (EDs) are subsequently admitted to hospital each year, making LBP the ninth most common reason for hospital admission in Australia. No studies have investigated and quantified the extent of clinical variation in hospital admission following an ED presentation for LBP.
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.
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 = 0.10), 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.
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.
每年有六分之一因腰痛（LBP）就诊于急诊科（ED）的患者随后被收入住院治疗，这使得 LBP 成为澳大利亚第 9 种最常见的住院原因。尚无研究调查和量化因腰痛在 ED 就诊后住院的临床变异程度。
我们使用澳大利亚新南威尔士州公立医院的常规收集 ED 数据，以确定年龄在 18 至 111 岁之间、出院诊断为 LBP 的患者的就诊情况。我们拟合了一系列随机效应多水平逻辑回归模型，通过病例组合和医院变量进行调整。主要结局是医院调整后的入院率（HAAR）。数据以带有 95%和 99.8%置信区间的漏斗图呈现。HAAR 在 95%置信区间之外的医院被认为与州平均水平的 HAAR 显著不同。
我们在 177 家公立医院 ED 共识别出 176729 例 LBP 就诊和 44549 例住院（25.2%）。平均（SD）年龄为 51.8（19.5）岁，女性占 52%。医院因素解释了 10%的变异（ICC=0.10），中位数优势比（MOR）为 2.03。我们发现医院之间存在显著差异，HAAR 范围从 6.9 到 65.9%。在调整医院变量后，具有相似特征的医院之间仍然存在显著差异。
即使在考虑病例组合和医院特征后，我们发现因腰痛就诊于 ED 后住院的人数仍存在显著差异。鉴于这些住院治疗相关的巨大费用，我们的研究结果表明需要调查变异的来源，并确定观察到的变异是否合理或不合理。
