HEALTH SERVICE RESEARCH POSTER PRESENTATION ABSTRACTS
Please note: All posters will be displayed in
Salons 10-12.
THURSDAY, 10:15-11:00 AM
Johnston BC, Cramer K, Humphreys K, Vohra S.
Adverse events associated with spinal manipulation in
children: a systematic review.
CARE Program, Department of Pediatrics, University
of Alberta b.johnston@ualberta.ca
BACKGROUND: Spinal manipulation is a non-invasive
manual procedure applied to specific body tissues with therapeutic intent.
A variety of different care providers (e.g. physiotherapists, massage
therapists) may perform manipulation as part of their practice, but
it is most frequently performed by chiropractors. After natural health
product use, chiropractic is the most frequently used form of CAM, and
chiropractic care is the most established CAM discipline in North America.
In adults, estimates of the risk of serious events resulting from chiropractic
treatment vary from 1 in 400 000 to 1 in 3.85 million cervical spine
manipulations. Little effort has been made to generate similar pediatric
risk estimates.
OBJECTIVE: Systematically identify and synthesize
available data on adverse events associated with the chiropractic manipulation
of children and youth.
METHODS: A comprehensive search was performed
of eight major electronic databases (e.g. MEDLINE, AMED, MANTIS) from
inception to June 2005. Studies were included if: (i) they were a primary
investigation of chiropractic manipulation (i.e. observation studies,
controlled trials, surveys); (ii) the study population was 18 years
or younger; and (iii) they reported data on adverse events. Adverse
events derived from RCTs will be summarized using risk difference (with
corresponding 95% confidence intervals) since events are considered
rare. For observational studies and surveys, risk estimates will be
calculated using numerator (number of adverse events) and denominator
(estimated number of pediatric spinal manipulations).
RESULTS: Our search yielded 13916 references.
Reviewers identified 164 studies for potential inclusion; 58 references
were added by searching the grey literature. Of the 222 articles, 10
were included in our overview. In total we identified 14 cases (abstracted
from 10 primary studies included) of adverse events. Ten cases involved
serious adverse events (e.g. subarachnoidal hemorrhage, paraplegia),
two moderate adverse events (e.g. severe headache) and two involved
minor adverse events (e.g. mid-back soreness). Risk estimates will be
presented at the meeting. An additional 20 cases concerning adverse
events related to delayed or missed diagnoses were also identified.
CONCLUSION: Two major kinds of events were identified.
Those associated with harm post manipulation and those associated with
delayed or missed diagnoses. As passive surveillance (e.g. case reports)
does not provide reliable numerator data (due to under-reporting) or
any denominator data (i.e. number of people exposed), it cannot estimate
the incidence of AE. Conduct of a prospective population-based active
surveillance study to properly assess the possibility of rare, yet serious,
adverse events as a result of chiropractic manipulation in children
is needed.
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