The need for a chiropractic adverse events reporting system in Australia

To the Editor: Following media reports of a complaint to the Australian Health Practitioner Regulation Agency regarding a 4-month-old baby’s neck fracture following chiropractic treatment for apparent torticollis,1 the president of the Chiropractors’ Association of Australia stated that “not a single serious adverse event has been recorded in the literature (worldwide) involving a qualified chiropractor treating a child since 1992”.2 However, an examination of the medical literature on adverse events related to chiropractic reveals an interesting story. A PubMed search for “chiropractic adverse event(s)” identifies 18 primary research papers since 1992 that could be classified as examining adverse events, none of which were Australian.

Why are there no Australian reports of adverse events associated with chiropractic manipulation? The answer is strikingly simple — there is currently no adverse events reporting system for chiropractic in Australia. This lack of local data means we have to look internationally to gauge the likelihood of chiropractic adverse events. A 2002 Canadian study3 describes 23 cases of vertebral artery dissection associated with chiropractic manipulation over a 10-year period, suggesting a real risk associated with these techniques.

Adverse event reporting systems are crucial for maintaining quality and safety in health care. Such systems ensure that adverse events are reviewed, thus identifying root causes of error, minimising risk of recurrence, ensuring professional accountability and improving patient care.4 Recognition of adverse events is a fundamental principle of open disclosure, as highlighted by the Australian Commission on Safety and Quality in Health Care.5 Open recognition and analysis of adverse events fosters public trust in health organisations and individual health care providers. Mitigating risk through quality improvement has long been recognised by industries as distinct as aviation, construction and medicine. The chiropractic profession is no more immune to error than any other. A chiropractic adverse events reporting system would bring chiropractors in line with other Australian health professionals and fulfil public entitlement to safe, high-quality care.