title: A cumulative review of the range and incidence of significant adverse events associated with acupuncture.
abstract: OBJECTIVE
  To summarise the range and frequency of significant adverse events associated with acupuncture in order to provide evidence on which to base continuing efforts to improve the safety of acupuncture practice.
  
  
  METHODS
  Searches were conducted of computerised databases, previous reviews of case reports, population surveys, prospective surveys of acupuncture practice and relevant sections of textbooks for primary and secondary reports to indicate the range of significant adverse events associated with acupuncture. Data from prospective surveys of acupuncture were combined to estimate the incidence of serious adverse events.
  
  
  RESULTS
  A total of 715 adverse events was included. There were 90 primary reports of trauma, and 186 secondary reports; the most common were pneumothorax and injury to the central nervous system. Infection accounted for 204 primary reports and 91 secondary reports. Over 60% of these cases were hepatitis B. The next most common infection was of the external ear, as a complication of auricular acupuncture. The 144 miscellaneous events mainly comprised seizures and drowsiness judged severe enough to cause a traffic hazard. There were 12 primary reports of deaths. According to the evidence from 12 prospective studies which surveyed more than a million treatments, the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10 000 treatments, and 0.55 per 10 000 individual patients.
  
  
  CONCLUSIONS
  The risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. The range of adverse events reported is wide and some events, specifically trauma and some episodes of infection, are likely to be avoidable.
authors.affiliation: Peninsula Medical School, Plymouth, UK. adrian.white@pms.ac.uk
authors.forename: Adrian
authors.initials: A
authors.lastname: White
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data*; D002493:Central Nervous System Diseases / Q000209:etiology; D006801:Humans; D015994:Incidence; D007239:Infections / Q000209:etiology; D011030:Pneumothorax / Q000209:etiology; D011446:Prospective Studies; D012107:Research Design; D018570:Risk Assessment; D012307:Risk Factors