To summarise the published evidence on potentially life-threatening adverse complications after acupuncture.

A search using the terms 'acupuncture' and 'adverse' was performed on MEDLINE from 1969 to 1996 and other specialised databases, e.g. CISCOM. Additional relevant studies were obtained by searching the authors' collection of relevant papers, by consulting experts working in the field, and by screening the bibliographies of all identified articles

Study designs of evaluations included in the review

The studies included case reports, case series, clinical trials or reviews relating to life-threatening adverse effects in human patients.

Specific interventions included in the review

Acupuncture.

Participants included in the review

Patients who experienced life-threatening events allegedly caused by acupuncture were included.

Outcomes assessed in the review

The outcome assessed was that of a life-threatening event classified as miscellaneous.

How were decisions on the relevance of primary studies made?

The authors do not state how the papers were selected for the review, or how many of the authors performed the selection.

The authors do not state that they assessed validity.

The authors do not state how the data were extracted for the review, or how many of the authors performed the data extraction.

How were the studies combined?

The studies were combined in a narrative review.

How were differences between studies investigated?

The authors do not state how differences between the studies were investigated.

Fifty-six studies fitting the inclusion criteria were identified.

Five fatalities were documented including 2 septicaemia, 2 cardiac tamponade and 1 acute asthmatic attack. Adverse reactions reported were: infections including hepatitis B, HIV and sub-acute bacterial endocarditis; trauma including pneumothorax and cardiac tamponade; miscellaneous including dermatitis, spinal cord injury and suppression of a demand pacemaker by electromagnetic interference.

Serious adverse events have been associated with acupuncture though the incidence is unknown. Acupuncturists should demonstrate how successfully they minimise the risks, and put in place regulatory and surveillance systems that enable the extent of the problems to be defined.

This review mentions some of the adverse reactions allegedly caused by acupuncture. Details of the 'specialised databases' searched are lacking, as is information on the sources of the authors' collection of papers on the subject. The combination of the search strategy outlined and contact with other experts may have revealed most of the relevant studies, but without more details of the sources used it is not possible to be certain of this. There was no critical assessment of the primary studies.

As the author correctly points out, there are problems with proof of causality, the incidence of adverse reactions is unknown, and there is a possibility that many cases may not be reported and those reported may not be published; these factors may result in an incomplete catalogue of adverse events.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.