Are serious adverse events associated with conservative physical procedures of the neck potentially preventable? A sub-analysis of a systematic review

Background

Recent guidance to clinicians has suggested that serious adverse events (SAEs) in cervical management occur due to insufficient history taking, missing existing underlying pathology, risk factors, or contraindications to physical therapies, rather than the intervention itself. This sub-analysis examines the evidence for inappropriate patient selection or whether the intervention itself may have been at fault.

Methods

Case reports from a previous systematic review of 334 cases were inspected and categorised into ‘potentially preventable’, ‘not preventable’, based on inappropriate patient selection or intervention or were 'unable to tell'.

Results

Sufficient information was provided for 176/334 (53 %) cases, 153 out of 176 cases (87 %) appeared potentially preventable with 55 related to inappropriate patient selection (12 missed diagnosis, 20 missed risk factors and 23 missed contraindications). Inappropriate treatment appeared to be related in 67 cases, (41 with improper technique application, e.g. strong or unconventional cervical manipulation or needling, eight involving untrained operators, five where treatment was not indicated, seven from continuing ineffective treatment and six where treatment continued despite adverse symptoms). In 31 cases there were multiple reasons. Forty cases occurred within the last decade, highlighting the continued relevance of improving safety measures around conservative neck interventions.

Conclusion

Despite the emergence of clinical guidelines and frameworks, the study suggests that many reported SAE cases may still have been preventable. To aid clinicians, simple, time-efficient tools assisting serious pathology recognition, risk assessment, patient monitoring, and specific technique guidance are paramount. Raising public awareness about potential risks of cervical procedures may also be warranted.