Reports suggest that chiropractic accounts for a large percentage of visits to alternative health practitioners. Moreover, pediatric patients represent a significant proportion of these visits. In light of this trend, it is important to evaluate the risk potential to the pediatric patient presenting for chiropractic care. This paper has reviewed literature concerning the occurrence of neurological and/or vertebrobasilar (N/VB) complications in patients receiving either specific chiropractic adjustments and/or non-specific manipulations of the spine. This topic was chosen due to the potentially severe consequences of N/VB complications, regardless of etiology. The current study was conducted in a quasi-meta analysis format to derive data for the period encompassing 1977 through the first quarter of 1998, using an eclectic compilation of data from three survey sources. Based on this information, the number of pediatric visits, extrapolated to also include the periods between 1966 and 1977, was estimated to be 502,184,156. Reports of the occurrence of N/VB complications in chiropractic pediatric patients were also investigated over the same time period by searching the scientific/clinical literature. The estimate of risk due to the pediatric chiropractic patient in this category of complication was estimated to be 4.0 x 10 -7 % of all visits. Stated otherwise, there would be a chance of approximately 1 in 250 million pediatric visits that a N/VB complication would result. While some pre-existing conditions may predispose a pediatric patient to a higher incidence of such complications, the estimates derived in the present study are considered applicable to the general pediatric population. The estimates derived in the present study are intended to be an initial risk assessment. Since very few reports exist relative to the incidence of N/VB complications in children, additional studies will be necessary to confirm this risk estimate.
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