Complementary Therapies in Medicine (2013) 21, 65—72

Available online at www.sciencedirect.com

journal homepage: www.elsevierhealth.com/journals/ctim

The role of acupuncture in emergency department

settings: A systematic review夽
Kun Hyung Kim a, Byung Ryul Lee b, Ji Ho Ryu c, Tae-Young Choi d,
Gi Young Yang b,∗

a
Department of Acupuncture & Moxibustion Medicine, Korean Medicine Hospital, Pusan National University, Yangsan, South Korea
b
Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, South Korea
c
Department of Emergency Medicine, School of Medicine, Pusan National University, Yangsan, South Korea
d
Korea Institute of Oriental Medicine, Daejeon, South Korea
Available online 29 December 2012

KEYWORDS Summary
Objectives: Patients with non-emergent and non-life threatening conditions often present to
Acupuncture;
the emergency department (ED), which hinders the efficient utilisation of healthcare resources.
Emergency
Acupuncture has frequently been used for such common conditions, although not in the ED
department;
context. This study aimed to evaluate the current evidence for acupuncture treatment in the
Systematic review;
ED and to inform future randomised controlled trials (RCTs) for acupuncture in ED settings.
Complementary and
Methods: Four English databases (MEDLINE, EMBASE, CENTRAL and AMED) were systematically
alternative medicine
searched to identify studies that tested the effects of acupuncture in ED settings using the
search terms of ‘‘acupuncture’’ and ‘‘emergency’’. Data extraction and the risk of bias assess-
ments were performed by two independent reviewers.
Results: Of the 102 screened studies, two RCTs and two uncontrolled observational studies were
deemed eligible. Sample sizes ranged from 42 to 100. The conditions treated included various
musculoskeletal and non-musculoskeletal symptoms and showed substantial clinical hetero-
geneity. Acupuncture was delivered in conjunction with standard medical care with the goal
of immediate pain alleviation; in one RCT, acupuncture resulted in a positive outcome, but
it did not in the other. The risk of bias was generally high or unclear. Uncontrolled studies
reported beneficial effects for acupuncture, although these studies were prone to bias. Two
studies reported mild and transient adverse events associated with acupuncture.
Conclusions: The current evidence is insufficient to make any recommendations concerning
the use of acupuncture in the ED. The effectiveness and safety as well as the feasibility of
acupuncture should be tested in future RCTs.
© 2012 Elsevier Ltd. All rights reserved.

夽 This study was supported by the Pusan National University Research Grant 2010. Choi T-Y was supported by Korea Institute of Oriental

Medicine (C12080 and K12130).

∗ Corresponding author at: Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 626-870, South

Korea. Tel.: +82 55 360 5963; fax: +82 55 360 5519.

E-mail address: iampnukh@gmail.com (G.Y. Yang).

0965-2299/$ — see front matter © 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ctim.2012.12.004
66 K.H. Kim et al.

Contents

Methods ................................................................................................................... 66
Study search.......................................................................................................... 66
Quality assessment ................................................................................................... 66
Data analysis ......................................................................................................... 66
Results .................................................................................................................... 67
General characteristics of included studies ........................................................................... 67
Risk of bias ........................................................................................................... 69
Adjunctive use of acupuncture with conventional ED management vs conventional ED management alone ........... 69
Adjunctive use of acupuncture in uncontrolled case series ........................................................... 70
Safety of acupuncture ................................................................................................ 70
Discussion ................................................................................................................. 70
Strengths and limitations ............................................................................................. 71
Implications for future research ...................................................................................... 71
Implications for clinical practice ..................................................................................... 71
Conclusion ................................................................................................................ 71
Conflict of interest statement ............................................................................................. 71
References .............................................................................................................. 71

Acupuncture is increasingly used for the management of
pain and other acute/chronic conditions in various clinical
settings. When acupuncture is used as a sole or adjunctive
treatment in general practitioner (GP) practices or tertiary
hospital settings, better health outcomes and less analgesic
consumption after acupuncture treatments were observed
which might contribute to the reduction of potentially harm-
ful drug over-consumption.1—4 However, extrapolation of
these data is often challenging, as the clinical context and
environment in the emergency department (ED) setting may
be significantly different from those noted in GP clinics or
other secondary/tertiary hospitals.5 Given this information,
it is important to analyse acupuncture use based on clini-
cal data generated in ED settings, for which there is very
limited evidence. This study aimed to systematically evalu-
ate the effectiveness and safety of acupuncture for various
conditions in ED settings. These data may thus inform rele-
vant factors necessary for the design of future randomised
controlled trials (RCTs).
Methods
evaluate the existing evidence of the most representative
type of acupuncture (i.e., needle insertion into the body).
Randomised or non-randomised controlled trials and
other uncontrolled case series were eligible, as it was
expected that there would be a paucity of literature for
the use of acupuncture in ED settings and our aim was to
identify the current status of evidence for this topic.
One author searched the database and screened poten-
tially eligible studies after reading the title and abstract
of identified studies. After the initial screening, which was
conducted by checking titles and abstracts, a more thorough
investigation was performed using full-text access. This pro-
cess was checked by a second author who was unblinded to
author’s name and affiliation of included studies. For eli-
gible RCTs, data extraction and a risk of bias assessment
were conducted independently by two authors. Detailed
characteristics in four domains (patients, intervention, com-
parison and outcomes) were extracted. For the extraction
of intervention-related information, the revised STandards
for Reporting Interventions in Clinical Trials of Acupunc-
ture (STRICTA) items were used to describe the details of
acupuncture treatments used in the study context.6

Study search
Four English databases (EMBASE, MEDLINE, AMED and CEN-
TRAL) were searched from their inception to July 2012.
Search terms included ‘acupuncture’ for intervention and
‘emergency’ for study setting. No terms about the study
design were set, as we expected to find only a small number
of previous studies in this field. No language restriction was
imposed.
We defined acupuncture as the insertion of a needle
at certain points of the body regardless of the underlying
theoretical framework (i.e., traditional Asian medicine
theory or Western medical acupuncture) and the subse-
quent use of stimulation methods (i.e., manual or electrical
stimulation). Acupuncture techniques that did not involve
needle insertion or point injection of herbal medicine were
excluded, as the aim of this systematic review was to
Quality assessment
The Cochrane risk of bias tool was used to assess the internal
validity of each study.7
The two authors independently assessed the risk of bias,
and any inconsistency in assessment results were discussed
with a third reviewer.
Data analysis
A qualitative summary of results in the included studies
was performed. Clinical heterogeneity was assessed through
data analysis. Where appropriate, we tried to conduct a
meta-analysis (quantitative analysis) with statistical hetero-
geneity assessment.
Acupuncture in emergency department settings 67

Idenficaon
English database (n =102)

Records after duplicates

removed (n = 102) Records excluded (n=80)
- Not relevant (n = 57)
Screening

-Not ED settings (n=3)

-Not clinical study (n=5)
-Not needle acupuncture (n=3)
Records screened -Case reports (n=8)
(n = 102 ) -Study protocol (n=1)
-Language not available (n=3)

Full-text articles assessed

Full-text articles excluded, with
for eligibility
Eligibility

reasons (n=18)
(n = 22 )
- Not ED settings (n=8)
-Case report (n=5)
-Not clinical study (n=3)
-Conference proceeding with
Studies included in insufficient reporting (n=1)
qualitative synthesis -Only for infants (n=1)
(n = 4)
- RCTs (n=2)
- UOSs (n=2)
Included

Studies included in
quantitative synthesis
(meta-analysis)
(n = 0 )

Figure 1 PRISMA flowchart of study selection. ED, emergency department; RCT, randomised controlled trial; UOS, uncontrolled
observational study.

Results extremities.10 In two RCTs, conventional ED management

Of the 102 initially searched hits, two RCTs and two uncon-
trolled observational studies (UOSs) were eligible and were
included in the analysis. Because only two RCTs with consid-
erable clinical heterogeneity were identified, quantitative
synthesis of the study results (meta-analysis) was not per-
formed. Fig. 1 illustrates the selection process for this
review.
General characteristics of included studies
Three studies8—10 were conducted in the U.S. and one case
series was conducted in Germany.11 Three studies were
conducted in the ED of a medical centre8—10 and one was
conducted in the general emergency service of the Red
Cross.11 Conditions for which acupuncture was employed
included acute pain syndromes,8 common acute conditions
with a range of musculoskeletal and non-musculoskeletal
symptoms9,11 and acute, non-penetrating injuries of the
served as the control. For three studies, concomitant treat-
ments included standard medical treatment in the ED.8,9,11
In one case series, analgesic medication was not allowed
during or before acupuncture treatment but other inter-
ventions for acute extremity injuries, for example, ice,
elevation and splinting, were provided when appropriate.10
The details of characteristics are provided in Table 1.
A variety of acupuncture techniques were identified in
the review. One RCT used only auricular acupuncture and
instructed patients to retain needles for 4 to 6 days after
administration of acupuncture.8 Another RCT employed
a mixture of auricular acupuncture, traditional Chinese
medicine (TCM) style body acupuncture, electroacupunc-
ture and active puncture techniques that involved an active
range of motion movements with distal-point needling.9 One
case series used TCM, Japanese Kiko Matsumoto, auricu-
lar and trigger point acupuncture.11 Another case series
did not specify which acupuncture technique was used.10
Acupuncture practitioners involved in the treatment were
reported to be licensed,10 use TCM style9 or be medical
 68
Table 1 Summary characteristics of included studies.

Study Design Patient Intervention Outcomes Summary of results

Harkin (2007)9 RCT (n = 45) (1) Age: Acupuncture (TCM style (1) Pain VAS Effects were similar in
(T/C) = (40.25 ± 14.68/ and auricular (2) Physiological parameters (respiratory both groups, showing
45.46 ± 16/18) acupuncture) plus rate, heart rate, systolic and diastolic blood 25.90 ± 17.64% and
(2) Female: conventional medical pressure) 22.18 ± 24.08% of pain
(T/C) = (42%/47%) treatments vs (3) Length of stay in ED reduction in acupuncture
(3) Condition: common conventional medical (4) Patient satisfaction with the treatment and control group,
acute conditions treatments alone Time points: immediate post-treatment respectively
including headache,
musculoskeletal pain and
other
non-musculoskeletal
symptoms
Goertz (2006)8 RCT (n = 100) (1) Age: Auricular acupuncture (1) Pain verbal NRS Significantly higher pain
(T/C) = (30.40 ± 9.67/ with standard medical (2) ED administration of medications and reduction in acupuncture
32.76 ± 7.45) care vs standard medical prescription information group (2.18 of mean
(2) Female: care alone (3) Medication consumption after discharge difference between
(T/C) = (42%/64%) Time points: groups) immediately
(3) Condition: acute pain immediate post-treatment and 24-h after after acupuncture
syndromes discharge treatment but similar at
24-h follow-up (0.37 of
mean difference
between groups)
Fleckenstein UOS (n = 60) (1) Age: 55.4 ± 23.0 Acupuncture (TCM and (1) 4-point symptom assessment scale Benefits were reported
(2011)11 (2) Female: 57% Japanese Kiko (marked, slight improvement, no change, after acupuncture
(3) Condition: various Matsumoto style, deterioration) treatment.
symptoms including auricular and trigger (2) Symptom improvement VAS (in 21 of 60
nausea, pain, dyspnea points) with emergency patients)
and other symptoms medical interventions Time points:
immediate post-treatment
Arnold (2009)10 UOS (n = 20) (1) Age: 33.0 (SD not Acupuncture (details not (1) Pain NRS Benefits were reported
reported) reported) with the (2) Patient satisfaction with acupuncture after acupuncture
(2) Female: 30% standard ED (3) Complication related to the acupuncture treatment with
(3) Condition: acute, interventions (ice, Time points: diminishing tendency of
non-penetrating injury elevation and splinting NRS measured immediately after observed effects at 72-h
of extremities, mainly when appropriate) acupuncture, 30 and 60 min follow-up.

K.H. Kim et al.

contusion and non-bony except the use of post-acupuncture
injury of a joint traditional analgesic All outcomes were measured within 72 h of
medication discharge by telephone interview
Abbreviations: RCT, randomised controlled trial; UOS, uncontrolled observational study; T/C, treatment group/control group; TCM, traditional Chinese medicine; VAS, visual analogue
scale; ED, emergency department; SD, standard deviation; VAS, visual analogue scale; NRS, numeric rating scale.
Acupuncture in emergency department settings 69

acupuncturists.8 One case series did not report the quali-
fications of the acupuncture practitioner.11 In all included
studies, patients were included after the ED physician con-
firmed that it was appropriate for the subject to participate
in the acupuncture treatments. In one study, acupunc-
ture treatments were allowed for 3—5 min.11 Goertz et al.
reported the administration of auricular acupuncture on
the two fixed points, a seemingly rapid procedure that
required notably less time when compared to traditional
body acupuncture, although no information on the total
treatment time in the ED department was reported.8 One
case series found that the median length of stay in the ED
was 135 min for patients who received acupuncture, while
it was 90 min in patients who did not receive acupuncture
treatments. The authors suggested that this was an accept-
able amount of time for acupuncture treatment in the ED.10
In the RCT conducted by Harkin and Parker9 , an acupunc-
turist consultation, which lasted 30—40 min with 20 min of
electroacupuncture stimulation, was provided. This type of
consultation may require considerable amounts of time in ED
settings.9 The full details of the acupuncture intervention
are described in Appendix 1.
Risk of bias
In two RCTs, the lack of patient and practitioner blinding
was a major source of risk of bias. The RCT by Harkin and
Parker9 generally showed high or unclear risk of bias in all
of the seven predefined domains, whereas that of Goertz
et al. showed low risk of bias in the random sequence gen-
eration, allocation concealment, outcome assessor blinding
and incomplete outcome reporting.8 Details of the risk of
bias assessment are provided in Table 2.
Adjunctive use of acupuncture with conventional
ED management vs conventional ED management
alone
In one RCT, 100 patients with acute pain syndromes
presenting to the ED were randomised into either an
acupuncture group or a standard medical care group.8 The
mean (standard deviation) baseline pain level as measured
by a numeric rating scale (NRS) was 6.98 (1.68) and 7.78
(1.84) in the acupuncture and standard medical care group,
respectively, suggesting a severe degree of baseline pain
in all participants. Immediately after a single session of
auricular acupuncture treatment, the mean change in the
pain visual analogue scale (VAS) was 2.33 (1.99) and 0.15
(0.59) in the acupuncture and standard medical care group,
respectively, showing statistically significant mean differ-
ences between the groups. However, the difference was
diminished when measured at a 24-h telephone follow-up
(the mean change in the pain VAS was 3.41 and 3.05 in the
treatment and control groups, respectively). The authors
reported an assessment of medication administration and
prescription information in the ED as well as medication
consumption after the emergency room (ER) visit. How-
ever, those results were not fully reported, and the authors
stated that no statistically significant difference between
the groups was observed.
In another RCT, 45 patients were randomised to either
the acupuncture group (n = 32) or the conventional treat-
ment group (n = 13).9 Immediately after a single session of
acupuncture treatment, pain scores were equally decreased
from moderate to severe levels to mild levels (from 64.3%
and 54.7% to 38.4% and 32.8% in the acupuncture and control
groups, respectively). Other physiological parameters, such
as respiratory rate, heart rate and systolic and diastolic

Table 2 Risk of bias in included RCTs.

Domains Goertz (2006)8 Harkin (2007)9

Assessment Description Assessment Description

Random sequence generation L A computer random number U No report on

Allocation concealment
Patient blinding
Practitioner blinding
Outcome assessor blinding
Incomplete outcome reporting
Selective outcome reporting
Other sources of bias
Abbreviations: RCT, randomised controlled trial; L, low risk of bias; H, high risk of bias; U, uncertain risk of bias. Risk of bias was assessed
by the Cochrane review handbook.7
generator was used.
L A set of sealed, numbered
opaque envelops was used.
H No blinding
H No blinding
L Outcome assessors were
blinded.
L Missing outcome data were
balanced in numbers across
two groups.
U Do not know whether
research protocol is
available
H The number of female is not
balanced across two groups.
randomisation methods
U No report on allocation
concealment
H No blinding
H No blinding
H No blinding
U No information on the
number of patients who
underwent
post-treatment
assessment
U Do not know whether
research protocol is
available
L No other remarkable
sources of bias
70
blood pressure, were also measured with no significant
between-group differences at post-treatment assessment.
The length of ED stay and patients’ self-perceived effects of
the given treatments were similar in both groups. Willing-
ness to undergo the assigned treatments in the future was
reported in 27 of 32 patients in the acupuncture group and
10 of 13 in the standard care group. Overall, acupuncture
showed similar effects when compared to the conventional
treatment group with respect to acute pain management
and patient-perceived effectiveness.
Adjunctive use of acupuncture in uncontrolled
case series
Two uncontrolled case series reported the beneficial effects
of acupuncture.10,11 Outcomes were measured using the VAS
for pain, pain NRS, patient-reported 4-point scale (marked
improvement, slight improvement, no change or symptom
deterioration) and patients’ satisfaction with acupuncture
treatment. Both studies assessed outcomes immediately
after acupuncture treatment. One study further measured
pain using the VAS at 30 and 60 min post-acupuncture treat-
ment and showed a reduction in pain.10 Telephone follow-up
within 72 h of discharge was conducted to measure pain NRS,
patient satisfaction and adverse events. Of the 20 patients,
13 patients responded to the follow-up telephone interview
and were noted to have a median NRS score of 3 out of 10.
The authors stated that this score was similar to that of the
historical control group (patients treated in the ED without
acupuncture treatment), which was noted to be 2.5 out of
10.
Safety of acupuncture
Adverse events associated with acupuncture were reported
in one RCT and one case series.9,10 Adverse events were
observed in 6 of 32 patients in the acupuncture group in one
RCT and occurred 14 times in the treatment of 20 patients in
one case series. All of these adverse events were minor and
transient. Reported adverse events included pain and minor
bleeding at the needled site, light-headedness, sweating,
itching and erythema at the puncture site.
Discussion
In this review, we found that only two RCTs were available
that had studied the use of acupuncture in the ED with a
relatively small number of participants. No sham-controlled
studies were found, demonstrating the lack of evidence for
the specific effects of acupuncture in ED settings as well
as the focus of previous research on the adjunctive use
of acupuncture to standard medical care in the ED. The
use of acupuncture in addition to standard medical care
in the ED showed inconsistent outcomes with respect to its
analgesic effects immediately after acupuncture treatment
(one study showed favourable outcomes with acupuncture,
while the other did not). After discharge from the ED,
patient-reported pain relief was similar in both groups,
suggesting the short-term effects of a single acupuncture
session in an ED setting. This tendency was also observed
K.H. Kim et al.
in an uncontrolled case series. Two uncontrolled studies
reported beneficial outcomes immediately after acupunc-
ture treatment, although the significant risk of bias due
to their uncontrolled nature prohibited the estimation of a
causal relationship between acupuncture treatment and the
observed beneficial outcomes. Risk of bias was also evident
in two RCTs due to their unblinded design. The non-specific
effects of acupuncture, for example, the effects of con-
text and the additional attention devoted to patients in the
acupuncture group during administration of acupuncture,
may have played a role in the overall observed benefits in
the acupuncture group. Overall, the current evidence found
in this study was insufficient to accept or repute the use of
acupuncture in the ED settings.
Although the evidence concerning the effectiveness of
acupuncture in symptom management in the ED cannot be
determined, some of the included studies aimed to test the
feasibility of acupuncture treatment in the ED setting.9,10
At least in the context of the included studies, it seems
feasible to test the role of acupuncture treatment in ED sett-
ings. However, the studies were primarily conducted in the
U.S. and Germany, and the feasibility of acupuncture treat-
ment in the ED in different contexts or countries may not
be the same as those in included studies. Because there are
only two RCTs, studies testing the feasibility of acupuncture
treatment should also be replicated in different contexts.
A single-session acupuncture treatment was performed
in all studies, which may not be clinically valid for other
chronic conditions or in different clinical settings (e.g., pri-
mary care clinics or inpatient wards). This may partially
explain the diminished effects of acupuncture after the
discharge of ED. Given the limited time and resources for
acupuncture treatments in conventional ED settings, how-
ever, it is unclear whether cumulative administration of
acupuncture is feasible in current ED settings. Whether and
how more sessions of acupuncture could be provided in ED
settings for better clinical outcomes should be explored in
future research.
Both musculoskeletal and non-musculoskeletal condi-
tions were treated in these studies, and the conditions
were characterised by heterogeneous disease characteris-
tics. Although individualised acupuncture treatments were
used based on various theoretical frameworks (i.e., TCM,
Korean, Japanese and trigger point acupuncture) in the two
studies, conditions with different pathologies and charac-
teristics may have diluted the effect of acupuncture, which
were assessed using a single outcome (e.g., VAS). This might
also partially explain the diminished effects of acupuncture
over time. Subgroup analysis by the treated conditions was
not available from the included studies due to the fact that
treatment results were not presented by condition. In future
trials, fewer heterogeneous inclusion criteria with respect to
disease condition may improve the interpretability of study
results. For example, a study protocol of multicentre RCTs
for acupuncture in low back pain, ankle sprain and migraine
through the EDs of four large tertiary teaching hospitals in
Australia was recently published.12 In that study, both pain
ratings on the VAS as a primary outcome and condition-
specific functional outcomes as secondary outcomes are to
be measured.
The integration of various health-care interventions,
for example, physical therapy13,14 and allied health
Acupuncture in emergency department settings
interventions,15 for non-life-threatening conditions in the
ED was encouraged to improve the treatment process and
clinical outcome and to enhance the cost-effectiveness of
medical services in the ED. In our review, simple clinical
outcomes, including the pain VAS or patients’ self-perceived
improvements, were reported. How the use of acupuncture
treatment can make the triage process or the fast-track
management of common non-life-threatening conditions
more efficient was not formally addressed in the included
studies. However, it is an important research agenda with
respect to the utilisation of acupuncture in the ED. Future
studies should also address the process- and cost-related
benefits of acupuncture use in the ED.
Strengths and limitations
To the best of our knowledge, this is the first systematic
review of the role of acupuncture treatment in ED settings.
This review is based on two small RCTs; thus, we found insuf-
ficient evidence concerning the use of acupuncture in an
ED setting. However, this study also highlights the need for
future research to address the paucity of evidence found
in the review process. Although we imposed no language
restriction on the search strategy, only English databases
were searched, and some studies that reported in Russian
and French were excluded due to resource limitation. Thus,
those excluded studies as well as potential unidentified eli-
gible studies indexed in local non-English databases (such as
Chinese and Korean databases) may exist. Thus, our review
may be susceptible to language bias. The simple search
terms used in this study may not detect potentially relevant
articles that deal with more specific topics (e.g., acupunc-
ture and acute conditions), and this should be pointed out
as a limitation of our study. Finally, this review focussed
on the qualitative synthesis of trial results and the assess-
ment of internal validity. Thus, the external validity and
generalisability of our study results are beyond the scope
of this review, although they are important for the replica-
tion of study results or the inclusion of evidence into clinical
guidelines.16
Implications for future research
Large, well-conducted RCTs should be performed to eval-
uate the effectiveness of acupuncture in the ED setting.
The feasibility, acceptability and outcomes associated with
health-care resource utilisation should also be tested and
replicated in various ED contexts. Observational studies
regarding the safety of acupuncture and the acceptabil-
ity of acupuncture both to ED staff and to patients may
be conducted in EDs that are already running acupuncture
treatment in conjunction with conventional ED treat-
ments. Study reporting should adhere to the CONSORT and
acupuncture-specific CONSORT extension (i.e., STRICTA) to
understand the detailed study context and procedure as well
as to maximise the external validity of trial results.
Implications for clinical practice
The current evidence is insufficient to provide any rec-
ommendation concerning the utilisation of acupuncture
71
in the ED setting. The studies identified showed that it
was feasible to provide acupuncture treatment in the ED
for non-emergent musculoskeletal pain and other non-
musculoskeletal conditions, although this may not be the
case in different ED settings and cultures. Adverse events
associated with acupuncture were minimal. However, more
data on the safety of acupuncture practised in the ED are
needed, as the risk of context-specific adverse events (e.g.,
forgotten needles in a busy ED context that may cause
migration of needles, which should be removed by surgical
interventions) could not be excluded. Overall, the routine
use of acupuncture in the ED will not be supported until more
sound evidence is established by several well-conducted
RCTs that address the feasibility, clinical effectiveness and
safety of acupuncture.
Conclusion
There is insufficient evidence for the use of acupuncture
in ED settings. The paucity of RCTs and the suboptimal
methodological qualities used in the studies are the primary
barriers for evaluating the evidence on this topic. Future
well-conducted RCTs are needed to determine whether
acupuncture can be established as an adjunctive or stand-
alone treatment option for common non-life-threatening
conditions in the ED.
Conflict of interest statement
None declared.
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