title: The quality of reports on cervical arterial dissection following cervical spinal manipulation.
abstract: BACKGROUND
  Cervical artery dissection (CAD) and stroke are serious harms that are sometimes associated with cervical spinal manipulation therapy (cSMT). Because of the relative rarity of these adverse events, studying them prospectively is challenging. As a result, systematic review of reports describing these events offers an important opportunity to better understand the relation between adverse events and cSMT. Of note, the quality of the case report literature in this area has not yet been assessed.
  
  
  OBJECTIVE
  1) To systematically collect and synthesize available reports of CAD that have been associated with cSMT in the literature and 2) assess the quality of these reports.
  
  
  METHODS
  A systematic review of the literature was conducted using several databases. All clinical study designs involving CADs associated with cSMT were eligible for inclusion. Included studies were screened by two independent reviewers for the presence/absence of 11 factors considered to be important in understanding the relation between CAD and cSMT.
  
  
  RESULTS
  Overall, 43 articles reported 901 cases of CAD and 707 incidents of stroke reported to be associated with cSMT. The most common type of stroke reported was ischemic stroke (92%). Time-to-onset of symptoms was reported most frequently (95%). No single case included all 11 factors.
  
  
  CONCLUSIONS
  This study has demonstrated that the literature infrequently reports useful data toward understanding the association between cSMT, CADs and stroke. Improving the quality, completeness, and consistency of reporting adverse events may improve our understanding of this important relation.
authors.affiliation: Texas Chiropractic College, Pasadena, Texas, United States of America. swynd@txchiro.edu
authors.forename: Shari
authors.initials: S
authors.lastname: Wynd
authors.forename: Michael
authors.initials: M
authors.lastname: Westaway
authors.forename: Sunita
authors.initials: S
authors.lastname: Vohra
authors.forename: Greg
authors.initials: G
authors.lastname: Kawchuk
mesh_terms: D002574:Cervical Vertebrae; D006801:Humans; D020393:Manipulation, Spinal / Q000009:adverse effects*; D012107:Research Design / Q000592:standards; D020521:Stroke / Q000209:etiology; D020217:Vertebral Artery Dissection / Q000175:diagnosis / Q000209:etiology*