Needle length and incidence of local reactions to immunisation
Authors: J. Platt
Journal: BMJ (2001)

# How quickly can research change practice? {#article-title-2} EDITOR—The paper by Diggle and Deeks was fast tracked in the hope of avoiding the five year delay that often occurs between the emergence of new evidence and a change in practice.1 I think that in this case there has already been major delay. A Medline search quickly produces several papers on this subject. Ipp et al noted that more redness and swelling occurred in children injected in the thigh with a 16 mm needle than with a 25 mm needle.2 The nature of the evidence also needs to be considered. This study used a standardised injection technique, but other techniques are used in practice, and Groswasser et al reported that injection technique is the most important variable in ensuring efficient delivery of intramuscular vaccine.3 Consequently, the injection technique chosen determines the appropriate needle size. The question of which needle length is preferable has been around for a long time, and the answer is relatively easy to obtain. We might still have to wait several years, however, for any change in practice. 1. 1.↵1. Diggle L, 2. Deeks J .Effect of needle length on incidence of local reactions to routine immunisation in infants aged 4 months: randomised controlled trial.BMJ2000; 321:931–933. (14 October.) [OpenUrl][1][Abstract/FREE Full Text][2] 2. 2.↵1. Ipp MM, 2. Gold R, 3. Goldbach M, 4. Maresky DC, 5. Saunders N, 6. Greenberg S, 7. et al .Adverse reactions to diphtheria, tetanus, pertussis-polio vaccination at 18 months of age: effect of injection site and needle length.Pediatrics1989; 83:679–682. [OpenUrl][3][Abstract/FREE Full Text][4] 3. 3.↵1. Groswasser J, 2. Kahn A, 3. Bouche B, 4. Hanquinet S, 5. Perlmuter N, 6. Hessel L .Needle length and injection technique for efficient intramuscular vaccine delivery in infants and children evaluated through an ultrasonographic determination of subcutaneous and muscle layer thickness.Pediatrics1997; 100:400–403. [OpenUrl][5][FREE Full Text][6] # Further research is needed before practice is changed {#article-title-6} EDITOR—The study by Diggle and Deeks on needle length and local reactions could lead to an interesting change in practice, although I do have several criticisms of the study and think that further research is needed.1 Firstly, I am surprised by the design of the study, as no … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DDiggle%26rft.auinit1%253DL.%26rft.volume%253D321%26rft.issue%253D7266%26rft.spage%253D931%26rft.epage%253D933%26rft.atitle%253DEffect%2Bof%2Bneedle%2Blength%2Bon%2Bincidence%2Bof%2Blocal%2Breactions%2Bto%2Broutine%2Bimmunisation%2Bin%2Binfants%2Baged%2B4%2Bmonths%253A%2Brandomised%2Bcontrolled%2Btrial%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.321.7266.931%26rft_id%253Dinfo%253Apmid%252F11030682%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=bmj&resid=321/7266/931&atom=%2Fbmj%2F322%2F7284%2F492.atom [3]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DIpp%26rft.auinit1%253DM.%2BM.%26rft.volume%253D83%26rft.issue%253D5%26rft.spage%253D679%26rft.epage%253D682%26rft.atitle%253DAdverse%2BReactions%2Bto%2BDiphtheria%252C%2BTetanus%252C%2BPertussis-Polio%2BVaccination%2Bat%2B18%2BMonths%2Bof%2BAge%253A%2BEffect%2Bof%2BInjection%2BSite%2Band%2BNeedle%2BLength%26rft_id%253Dinfo%253Apmid%252F2717284%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=83/5/679&atom=%2Fbmj%2F322%2F7284%2F492.atom [5]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DGroswasser%26rft.auinit1%253DJ.%26rft.volume%253D100%26rft.issue%253D3%26rft.spage%253D400%26rft.epage%253D400%26rft.atitle%253DNeedle%2BLength%2Band%2BInjection%2BTechnique%2Bfor%2BEfficient%2BIntramuscular%2BVaccine%2BDelivery%2Bin%2BInfants%2Band%2BChildren%2BEvaluated%2BThrough%2Ban%2BUltrasonographic%2BDetermination%2Bof%2BSubcutaneous%2Band%2BMuscle%2BLayer%2BThickness%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.100.3.400%26rft_id%253Dinfo%253Apmid%252F9282716%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [6]: /lookup/ijlink?linkType=FULL&journalCode=pediatrics&resid=100/3/400&atom=%2Fbmj%2F322%2F7284%2F492.atom