Midterm - PARQ Flashcards
Define complication rates (council for international organizations of medical sciences)
- Very common >/= 1:10
- common (frequent) = >/=1:100 (but less then 1:10)
- uncommon (infrequent) >/= 1:1,000 (but less then 1:100)
- rare >/= 1:10,000 (but less tan 1:1,000)
- very rare <1:10,000
Complications to treatments -certain?
- Effect has clear, proximate time relationship to treatment
- Effect cannot be explained by preexisting disease or treatments
- Effect can be caused by the treatment (biological plausibility or better)
- Effect is real and not purely perceived (actual demonstrable pathology)
Complication to treatment - probable?
- Effect has a reasonable time relationship to treatment
- Effect, while possibly attributable to the disease or comorbid disease or treatments is more likely caused by the treatment
- Effect can be caused by the treatment (biological plausibility or better)
- Effect is real and not purely perceived (actual demonstrable pathology)
Complication to treatment - possible?
- Effect has a reasonable time relationship to treatment
- It is not possible to discern whether the effect was caused by something other than the treatment of interest (these “other” potential causes should be identifiable, not just “dunno, something else must have done it)
- Effect can be caused by the treatment (biological plausibility or better)
- Effect is real and not purely perceived (actual demonstrable pathology)
Complication to treatment - unlikely?
- Effect has an improbable time relationship to the treatment in question (not impossible, but improbable- clearly less likely than likely)
- Other causes for the effect are clearly more likely than the treatment in question for causing the effect
- The effect is not reasonably possible from the treatment
- The effect is real and not purely perceived
Minor, Benign or self-limiting-
brief in duration (usually less than 48 hours),
requiring no further assessment or treatment
Intermediate adverse reaction
symptoms sustained beyond 48 hours, often requiring additional assessment or treatment focused on the complication
Severe adverse reaction
life-threatening, requiring assessment and treatment, potential cause of permanent disability or death
If an adverse reaction is moderate and rare should you discuss it?
Depends…may not need to discuss it but abundance of caution likely favors discussion
If an adverse reaction is major and very rare should you discuss it?
Depends on what it is….
- CVA - yes, very rare and yet discussed
- death from exsanguination due to lumber manipulation? No
Approximately _____% of manipulations conducted in the US are delivered by chiropractic physicians
95%
No other licensed profession in the US receives nearly the education and training in delivering
manipulation as DCs
Minor or benign events occur in _________ of patients (Very Common)- available data reports primarily on
_____ patients.
These include _____, _____, ______, ______
__% are gone writhing ____ hours and nearly all abate by _____
30-60%
New patients
- soreness of muscles
- local tenderness in the area of manipulation
- headache
- increased intensity of pain
60%, 24, 48
Soreness of muscles is presumed to be due to
over-stretch and micro-tearing of contracted tissue or lysing of micro-adhesions in tenosynovial and tendinous tissues
Intermediate events occur ___ % of time
It includes ____, ____, ____
10% = common
- sustained, requiring treatment to address the adverse event
- pain that radiates into the extremity
- sprain/strain/internal derangement peri-articular or articular tissues
- iatrogenic fracture
Pain that radiates into an extremity May resolve spontaneously or require additional care… Believed to be
mechanical or chemical irritation of existing pathology near nerve roots (i.e. disc protrusion, stenosis, osteophytic ridge)
Sprain/strain/internal derangement peri-articular or articular tissues. Severity varies substantially from self-limiting to requiring retooling of
treatment priorities. May be exacerbation of _______. Results in________
a preexisting sprain/strain that results in prolonging or
worsening symptoms
- change in therapy due to symptoms
Iatrogenic fracture is due to
Normal forces applied to weakened bones
- Osteoporotic or osteomalacic bone
- Diseased bone due to neoplasm (benign or malignant) or significant metabolic disease
Excessive force or leverage applied to normal bones
- The role of manipulation in rib fractures is undisputed… compression fractures, perhaps not so much
Severe adverse events. All Very Rare. Injury that can or does result in ________.
Such as ______, ______, _____, ______
death, permanent disability or requires significant and invasive care (e.g. surgery) to respond to the injury
- cauda equina syndrome
- disc protrusion
- abdominal vascular injury
- vertebrobasilar artery dissection or thrombosis due to cervical spine manipulation
Cauda Equina Syndrome (CES) Incidence estimated at
1:100,000,000 to 1:128,000,000 manipulations
Disc protrusion (+/-) CES rate?
Best estimates are ______
1/1,000,000 to 1:2,789,709 manipulations
- 1:1,000,000 to 3-6 in 10,000,000 manipulations (includes CES)
- 3: 10,000,000= 1: 3.3 million
- 6: 10,000,000= 1: 1.67 million
Irritation of an existing disc protrusion is a _______ complication unless it results in _____
Moderate
Cauda Equina Syndrome or surgery to manage symptoms
Dissection or rupture of the aorta during lumbar spine manipulation- incidence estimated at _________ manipulations
1:100,000,000
Vertebrobasilar artery dissection or thrombosis due to cervical spine manipulation:
Range of estimates of frequency is _______
Best data suggests ______
1: 500,000 to 1: 10 million.
1: 2-10 million
Manipulation induced ____________ needs to be mentioned despite its rareness. Others such
as _______ and _______ from manipulation… not so much.
vertebrobasilar dissection, rupture or thromboembolic occlusion
cauda equina syndrome and aortic rupture
