Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study
Risk of Carotid Stroke after Chiropractic Care: A Population-Based Case-Crossover Study
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DOI：
10.1016/j.jstrokecerebrovasdis.2016.10.031
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发表时间：
2017-04-01
影响因子：
2.5
通讯作者：
Haldeman, Scott
中科院分区：
文献类型：
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作者：
Cassidy, J. David;Boyle, Eleanor;Haldeman, Scott
背景资料：捏脊是治疗颈痛和头痛的常用方法，但可能会增加颈动脉夹层和中风的风险。颈动脉夹层患者在中风前可能会出现颈部疼痛和/或头痛。这些都是脊医和初级保健医生（PCP）看到的常见症状。我们的目的是通过比较整脊治疗和PCP就诊与随后卒中之间的关系，评估整脊治疗后颈动脉卒中的风险。方法：在加拿大安大略进行了一项基于人群的病例交叉研究。确定了9年内所有入院的颈动脉卒中事件病例。病例作为自身对照。脊椎按摩疗法和PCP服务的暴露是根据健康账单记录确定的。结果：我们比较了15，523例病例和62，092个对照期，使用卒中前1、3、7和14天的暴露窗口。在45岁以下的患者中，脊椎指压治疗和PCP就诊与随后的卒中呈正相关。当分析仅限于颈部疼痛和头痛相关诊断的就诊时，这些关联倾向于增加。脊椎按摩疗法和PCP风险估计之间没有显着差异。我们发现45岁或以上的人群中脊椎指压治疗与中风之间没有联系。结论：我们没有发现脊椎按摩治疗后颈动脉中风的额外风险。脊椎指压治疗和PCP就诊与卒中之间的关系相似，可能是由于患者在发生卒中前有早期解剖相关症状寻求治疗。
Background: Chiropractic manipulation is a popular treatment for neck pain and headache, but may increase the risk of cervical artery dissection and stroke. Patients with carotid artery dissection can present with neck pain and/ or headache before experiencing a stroke. These are common symptoms seen by both chiropractors and primary care physicians (PCPs). We aimed to assess the risk of carotid artery stroke after chiropractic care by comparing association between chiropractic and PCP visits and subsequent stroke. Methods: A population-based, case-crossover study was undertaken in Ontario, Canada. All incident cases of carotid artery stroke admitted to hospitals over a 9-year period were identified. Cases served as their own controls. Exposures to chiropractic and PCP services were determined from health billing records. Results: We compared 15,523 cases to 62,092 control periods using exposure windows of 1, 3, 7, and 14 days prior to the stroke. Positive associations were found for both chiropractic and PCP visits and subsequent stroke in patients less than 45 years of age. These associations tended to increase when analyses were limited to visits for neck pain and headache-related diagnoses. There was no significant difference between chiropractic and PCP risk estimates. We found no association between chiropractic visits and stroke in those 45 years of age or older. Conclusions: We found no excess risk of carotid artery stroke after chiropractic care. Associations between chiropractic and PCP visits and stroke were similar and likely due to patients with early dissection-related symptoms seeking care prior to developing their strokes.