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Davidson et al’s findings, in their paper in this month’s Emergency Medicine Journal (EMJ), that ED patients presenting with low back pain have high self-presentation, admission and re-presentation rates are familiar to most of us irrespective of our ED settings.1 Davidson et al go on to assess whether a suite of quality improvement strategies for patients presenting with LBP improved ED performance indicators in a single-centre study.1 Although the impact on admission rates and length of stay was not statistically significant, the findings highlight challenges EDs face when managing this common presentation.