Objective: Ear acupuncture might be the form of acupuncture best suited to improving acute pain management in the emergency department (ED). The primary aim of this review was to assess the analgesic efficacy of ear acupuncture in the ED. Secondary outcomes included measures of patient satisfaction, adverse effects, cost, administration techniques, and reduction of medication usage. Methods: Seven databases and Google Scholar were searched up to April 27, 2017, using MeSH descriptors for three overarching themes (ear acupuncture, pain management, and emergency medicine). Meta-analyses were performed in 3 comparator groups: (1) ear acupuncture versus sham; (2) ear acupuncture-as-adjunct to standard care; and (3) ear acupuncture (both as sole therapy and adjuvant) versus control to calculate the standardized mean difference (SMD) and weighted mean difference (WMD) for pain scores out of 10. Results: Six randomized controlled trials and 2 observational studies, totaling 458 patients, were retrieved after exclusions. The meta-analysis used data from 4 randomized studies representing 286 patients. The above 3 comparator groups resulted in SMDs of 1.69, 1.68, and 1.66, and WMDs of 2.47, 2.84, and 2.61 respectively, all favoring acupuncture. Battlefield (ear) acupuncture was the most commonly used technique. There were no significant adverse effects and patient satisfaction improved. Results regarding if acupuncture reduced medication use were equivocal. Significant study bias and heterogeneity were found. Conclusions: While study numbers are limited, ear acupuncture, either as stand-alone or as-an-adjunct technique, significantly reduced pain scores and has potential benefits for use in the ED. Further studies will define acupuncture's role and if it reduces use of analgesic medications.

Acupuncture might offer a novel approach to improve ED pain management. Our primary aim was to assess the efficacy of acupuncture in the emergency setting while secondary objectives were to explore its suitability through its side-effect profile, patient satisfaction, cost, administration time and points used. Seven databases and Google Scholar were searched up to 31 July 2016 using MeSH descriptors for three overarching themes concerning acupuncture, pain management and emergency medicine. Meta-analysis was performed on randomised trials for three comparator groups: acupuncture versus sham, acupuncture versus standard analgesia care and acupuncture-as-an-adjunct to standard care, to calculate the standardised mean difference and weighted mean difference for pain scores out of 10. Data for secondary outcomes was extracted from both randomised and observational studies. Nineteen randomised controlled trials and 11 uncontrolled observational studies totaling 3169 patients were retrieved after exclusions. Meta-analyses were performed on data from 14 randomised controlled trials representing 1210 patients. The three resulting comparator groups (as above) resulted in standardised mean differences of 1.08, 0.02 and 1.68, and weighted mean differences of 1.60, -0.04 and 2.84, respectively (all positive figures favour acupuncture). Where measured, acupuncture appears to be associated with improved patient satisfaction, lower cost and a low adverse effects profile. The data available were inadequate to ascertain the effect of acupuncture on analgesia use. Significant study bias was found, especially with respect to practitioner and patient blinding. We conclude that for some acute pain conditions in the ED, acupuncture was clinically effective compared to sham and non-inferior to conventional therapy. As an adjunct, limited data was found indicating superiority to standard analgesia care. Further studies will elucidate the most appropriate acupuncture training and techniques, use as an adjunct and the clinical situations in which they can be best applied.

This article compares the mortality data for injuries in children aged 0–14 years in the World Health Organization WHO European region as estimated by the WHO Global Health Estimates for 2000 and 2015. While the region has seen a decline in child mortality due to injuries over the years, inequality persists between the low- and middle-income countries and high-income countries in the region. The gap in child mortality due to unintentional injuries has widened over the years between these two socioeconomic regions, particularly in terms of road injuries. In contrast, mortality rate ratios due to intentional injuries have narrowed between 2000 and 2015. The low- and middle-income countries need to scale up their efforts in injury prevention by adopting stricter regulations and higher safety practices to narrow the East-West gap in unintentional injuries.

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