Integrating acupuncture into emergency department care : a systematic review

Abstract

Background Traditional and complementary medicine is popular worldwide. Its integration with biomedicine is increasingly seen as a way to improve care quality and accessibility. Acupuncture is the most accepted and best studied modality of traditional Chinese medicine. Its integration into the emergency department (ED) has the potential of bringing substantial improvement in patient care. So far, there has been a lack of comprehensive reviews of the literature published in both English and Chinese. Objectives This research aimed to evaluate the current evidence for integrating acupuncture into the ED and summarize the best available evidence for clinical practice, future research, and health service planning. Methods Five English databases (CENTRAL, MEDLINE, EMBASE, CINAHL, and AMED) and two Chinese databases (CNKI and Wanfang) were systematically searched using the search terms ‘acupuncture’ and ‘emergency department’ and their variations, in both languages. A bibliographic search of references of all included studies and previous review articles was also performed. Randomised controlled trials (RCTs) or observational studies with a control group on the use of acupuncture in ED settings were selected based on pre-defined criteria. Data were extracted using a standardised data extraction form. The risk of bias assessment was performed by the author using the Cochrane risk of bias tool. The quality of evidence for each individual outcome was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results Of the 868 articles screened, four RCTs, two quasi-experimental studies and one observational study with historical controls were included. These studies involved 887 participants and were very heterogeneous in terms of study design, patient characteristics, interventions, comparisons, and outcome assessment. Acupuncture was superior to sham acupuncture, comparable to conventional ED treatment, and superior to standard ED care alone when combined with standard care in relieving pain caused by a variety of acute conditions, but the overall level of evidence for pain reduction in the ED is low because of limitations in the study designs and implementation. Studies that applied acupuncture in other acute conditions, such as cardiac arrest, nausea, dizziness and vertigo were in general subject to high risk of bias, and the level of evidence for these outcomes is very low. Utilization of acupuncture in the ED appeared to be safe with no serious adverse effects reported. Patients who accepted acupuncture were satisfied with the treatment. The introduction of acupuncture to the ED did not significantly prolong the waiting time to treatment, staff time required to manage patients, or ED length of stay. Medication prescription and use did not differ significantly when acupuncture was used with standard treatment for pain control. Conclusions There is insufficient evidence to draw any conclusion about the use of acupuncture in the ED. Integrating acupuncture in the ED is feasible and negative impacts on ED operations appear to be minimal. Yet, the optimal disease category, acupuncture technique, model of integration and service delivery remain unknown. More well-designed studies on the clinical efficacy, feasibility, and cost-effectiveness of acupuncture in the ED are warranted.