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Wrong Cohort to Reduce “Unnecessary” CT Imaging

Published:November 04, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.10.018
      We commend the authors on studying a robust database of over 1000 patients taking direct oral anticoagulants (DOACs) who sustained minor head trauma in their article in the current journal entitled “Analysis of clinical and laboratory risk factors of post-traumatic intracranial hemorrhage in patients on DOACs with mild traumatic brain injury: an observational multicenter cohort”. The methodology was sound. We agree with excluding patients who arrived 48 hours after their trauma (asymptomatic after 48 hours would not require head imaging), those that took their last dose of DOAC 24 hours prior to the head trauma (need for imaging does not need to factor in the risk of anticoagulation), and those that arrive with focal deficits (immediate imaging required). 6.8% of the cohort sustained an intracranial hemorrhage (ICH) and 1.5% required neurosurgery or died. These numbers are consistent with prior studies.
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