Wrong Cohort to Reduce "Unnecessary" Computed Tomography Imaging

Abstract

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 of Emergency Medicine 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 h after their trauma (asymptomatic after 48 h would not require head imaging), those that took their last dose of DOAC 24 h prior to the head trauma (need for imaging does not need to factor in the risk of anticoagulation), and those that arrived with focal deficits (immediate imaging required). There was 6.8% of the cohort that sustained an intracranial hemorrhage (ICH), and 1.5% required neurosurgery or died. These numbers are consistent with prior studies. Analysis of Clinical and Laboratory Risk Factors of Post-Traumatic Intracranial Hemorrhage in Patients on Direct Oral Anticoagulants with Mild Traumatic Brain Injury: An Observational Multicenter CohortJournal of Emergency MedicinePreviewAssessing the risk of intracranial hemorrhage (ICH) in patients with a mild traumatic brain injury (MTBI) who are taking direct oral anticoagulants (DOACs) is challenging. Currently, extensive use of computed tomography (CT) is routine in the emergency department (ED). Full-Text PDF