• Nøddeskou-Fink AH
• Jørgensen MS
• Hartvigsen J
• Christensen HW
• Stochkendahl MJ

• Adolescent
• Adult
• Affiliation / University of Southern Denmark. Center for Muscle and Joint Health
• Aged
• Chiropractic / economics
• Chiropractic / statistics and numerical data
• Compensation and Redress
• Female
• Male
• Manipulation, Chiropractic / adverse effects
• Manipulation, Chiropractic / economics
• Middle Aged
• Open Access Document
• Registries
• Retrospective Studies
• Young Adult

Background: Injuries sustained during healthcare consultations are a significant concern, and compensation claims relating to injuries in health systems are increasing. Extensive research has addressed injuries in the secondary sector, whereas knowledge about injuries sustained in primary care remains sparse. This retrospective register-based study aimed to describe compensation claims involving chiropractors in Denmark between 2013 and 2022.

Methods: All claims related to chiropractors from 2013 to 2022 were accessed in the Danish Patient Compensation Association Register and analyzed using the Healthcare Complaints Analysis Tool. Data on patient characteristics, injuries, processing time, decisions, appeals, and financial compensation were collected. Claims were categorized as relating to clinical, management, or patient-clinician relationship, alongside nine symptom-based injury classifications. Data relating to cervical artery dissection were examined separately and in greater detail, including information on presenting symptoms, International Classification of Primary Care, Second Edition code recorded by the chiropractor, treatment modalities used, time from treatment to onset of symptoms, and type of vascular injury subsequently diagnosed. Descriptive statistics summarized findings.

Results: A total of 535 chiropractor-related claims were identified, with 519 included for analysis. The number of claims per 100,000 consultations increased from 1.03 in 2013 to 3.57 in 2022. Most claims (84%) concerned treatment outcomes and side effects, primarily worsening of symptoms (23%) or delayed referral (23%). Of the 519 claims, only 32 (6%) were approved for compensation. Cervical artery dissection-related claims had the highest approval rate within category (29%; ~ 0.7 approved claims per million consultations) and accounted for 94% of total financial compensation (14 approved claims, 3,025,000 €).

Conclusion: Compensation claims related to chiropractic care in Denmark increased between 2013 and 2022, but approval rates remained low. Most claims concerned dissatisfaction with treatment outcome or worsening of symptoms. Cervical artery dissection-related claims had the highest approval rate and accounted for the highest compensation. When approved, they were compensated based on the fairness rule stating that the outcome could neither have been predicted nor expected from patients' individual cases. Better communication between patients and chiropractors about expectations for treatment, natural course of conditions, and expected reactions to treatment will likely reduce the number of claims.

Keywords: Adverse events; Cervical artery dissection; Chiropractic; Compensation claims; Healthcare; Injuries; Manual therapy; Primary care; Side effects.

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