{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:42:17Z","timestamp":1792806137432,"version":"4.5.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T00:00:00Z","timestamp":1713398400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background and importance<\/jats:title><jats:p>Mild traumatic brain injury (mTBI) is a frequent presentation in Emergency Department (ED). There are standardised guidelines, the Canadian CT Head Rule (CCHR), for CT scan in mTBI that rule out patients on either anticoagulant or anti-platelet therapy. All patients with these therapies undergo a CT scan irrespectively of other consideration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine whether standard guidelines could be applied to patients on anticoagulants or anti-platelet drugs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, settings, and participants<\/jats:title><jats:p>1,015 patients with mTBI and Glasgow Coma Score (GCS) of 15 were prospectively recruited, 509 either on anticoagulant or anti-platelet therapy and 506 on neither. All patients on neither therapy underwent CT scan following guidelines. All patients with mTBI on either therapy underwent CT scan irrespective of the guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measure and analysis<\/jats:title><jats:p>Primary endpoint was the incidence of post-traumatic intracranial bleeding in patients either on anticoagulants or anti-platelet drugs and in patients who were not on these therapies. Bayesian statistical analysis with calculation of Confidence Intervals (CI) was then performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Sixty scans were positive for bleeding: 59 patients fulfilled the criteria and 1 did not. Amongst patients with haemorrhage, 24 were on either therapy and only one did not meet the guidelines but in this patient the CT scan was performed before 2 h from the mTBI. Patients on either therapy did not have higher bleeding rates than patients on neither. There were higher bleeding rates in patients on anti-platelet therapy who met the guidelines vs. patients who did not. These rates overlapped with patients on neither therapy, meeting CCHR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The CCHR might be used for mTBI patients on either therapy. Anticoagulants and anti-platelet drugs should not be considered a risk factor for patients with mTBI and a GCS of 15. Multicentric studies are needed to confirm this result.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2024.1327871","type":"journal-article","created":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T05:06:36Z","timestamp":1713416796000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Use of the Canadian CT head rule for patients on anticoagulant\/anti-platelet therapy presenting with mild traumatic brain injury: prospective observational study"],"prefix":"10.3389","volume":"15","author":[{"given":"Laura","family":"Uccella","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Riboni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Polinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carola","family":"Biondi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graziano","family":"Uccheddu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Petrino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Majno-Hurst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1016\/j.apmr.2010.05.017","article-title":"Demographics and clinical assessment working Group of the International and Interagency Initiative toward common data elements for research on traumatic brain injury and psychological health. Position statement: definition of traumatic brain injury","volume":"91","author":"Menon","year":"2010","journal-title":"Arch Phys Med Rehabil"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1093\/neuros\/nyaa151","article-title":"A scoping review of registered clinical studies on mild traumatic brain injury and concussion (2000 to 2019)","volume":"87","author":"Furlan","year":"2020","journal-title":"Neurosurgery"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"688","DOI":"10.3171\/2009.2.JNS08909","article-title":"Prediction of intracranial computed tomography findings in patients with minor head injury by using logistic regression","volume":"111","author":"Saadat","year":"2009","journal-title":"J Neurosurg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e339","DOI":"10.1016\/j.wneu.2017.10.173","article-title":"Are antiplatelet and anticoagulants drugs a risk factor for bleeding in mild traumatic brain injury?","volume":"110","author":"Uccella","year":"2018","journal-title":"World Neurosurg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.1097\/TA.0b013e31823321f8","article-title":"Effect of the modified Glasgow coma scale score criteria for mild traumatic brain injury on mortality prediction: comparing classic and modified Glasgow coma scale score model scores of 13","volume":"71","author":"Mena","year":"2011","journal-title":"J Trauma"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1016\/s0140-6736(00)04561-x","article-title":"The Canadian CT head rule for patients with minor head injury","volume":"357","author":"Stiell","year":"2001","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1749-7922-9-31","article-title":"Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury","volume":"9","author":"Kavalci","year":"2014","journal-title":"World J Emerg Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1186\/s12913-020-5058-1","article-title":"Trends in anticoagulant prescribing: a review of local policies in English primary care","volume":"20","author":"Ho","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"638","DOI":"10.3389\/fneur.2019.00638","article-title":"Incidence of mild traumatic brain injury: a prospective hospital, emergency room and general practitioner-based study","volume":"10","author":"Skandsen","year":"2019","journal-title":"Front Neurol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/j.annemergmed.2008.08.021","article-title":"American College of Emergency Physicians; Centers for Disease Control and Prevention. Clinical policy: neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting","volume":"52","author":"Jagoda","year":"2008","journal-title":"Ann Emerg Med"},{"key":"ref11","year":"2023"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1002\/pds.3463","article-title":"Trends in the use of aspirin and nonsteroidal anti-inflammatory drugs in the general U.S. population","volume":"23","author":"Zhou","year":"2014","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.wneu.2016.05.061","article-title":"Mild traumatic brain injury in patients on long-term anticoagulation therapy: do they really need repeated head CT scan?","volume":"93","author":"Uccella","year":"2016","journal-title":"World Neurosurg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1097\/MEJ.0000000000000714","article-title":"Effect of the implementation of a new guideline for minor head injury on computed tomography-ratio and hospitalizations in the Netherlands","volume":"27","author":"Van den Brand","year":"2020","journal-title":"Eur J Emerg Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1017\/cem.2019.405","article-title":"Choosing wisely Canada's emergency medicine recommendations: time for a revision","volume":"21","author":"Cheng","year":"2019","journal-title":"CJEM"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s42466-018-0001-1","article-title":"GCS 15: when mild TBI isn't so mild","volume":"1","author":"Ganti","year":"2019","journal-title":"Neurol Res Pract"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1007\/s11739-020-02576-w","article-title":"Predictors of post-traumatic complication of mild brain injury in anticoagulated patients: DOACs are safer than VKAs","volume":"16","author":"Cipriano","year":"2021","journal-title":"Intern Emerg Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1007\/s11739-018-1806-1","article-title":"Intracranial hemorrhage in anticoagulated patients with mild traumatic brain injury: significant differences between direct oral anticoagulants and vitamin K antagonists","volume":"13","author":"Cipriano","year":"2018","journal-title":"Intern Emerg Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1037\/a0029146","article-title":"Bayesian estimation supersedes the t-test","volume":"142","author":"Kruschke","year":"2013","journal-title":"J Exp Psychol Gen"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1097\/01.ta.0000196542.54344.05","article-title":"Traumatic brain injury in anticoagulated patients","volume":"60","author":"Cohen","year":"2006","journal-title":"J Trauma"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.1007\/s10072-020-04313-9","article-title":"Acute alcohol intoxication as a confounding factor for mild traumatic brain injury","volume":"41","author":"Uccella","year":"2020","journal-title":"Neurol Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"724641","DOI":"10.3389\/fneur.2022.724641","article-title":"The impact of preinjury use of antiplatelet drugs on outcomes of traumatic brain injury: a systematic review and Meta-analysis","volume":"13","author":"Cheng","year":"2022","journal-title":"Front Neurol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1016\/j.annemergmed.2019.10.004","article-title":"Prevalence of intracranial injury in adult patients with blunt head trauma with and without anticoagulant or antiplatelet use","volume":"75","author":"Probst","year":"2020","journal-title":"Ann Emerg Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e000520","DOI":"10.1136\/tsaco-2020-000520","article-title":"Antiplatelet therapy is associated with a high rate of intracranial hemorrhage in patients with head injuries","volume":"5","author":"Alter","year":"2020","journal-title":"Trauma Surg Acute Care Open"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/neu.2015.4393","article-title":"Systematic review and Meta-analysis: is pre-injury antiplatelet therapy associated with traumatic intracranial hemorrhage?","volume":"34","author":"Van den Brand","year":"2017","journal-title":"J Neurotrauma"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1016\/j.jemermed.2019.09.007","article-title":"Direct Oral anticoagulant treatment and mild traumatic brain injury: risk of early and delayed bleeding and the severity of injuries compared with vitamin K antagonists","volume":"57","author":"Turcato","year":"2019","journal-title":"J Emerg Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"106518","DOI":"10.1016\/j.clineuro.2021.106518","article-title":"Assessing the efficacy of mild traumatic brain injury management","volume":"202","author":"Weber","year":"2021","journal-title":"Clin Neurol Neurosurg"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1327871\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,18]],"date-time":"2024-04-18T05:06:39Z","timestamp":1713416799000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2024.1327871\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,18]]},"references-count":27,"alternative-id":["10.3389\/fneur.2024.1327871"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2024.1327871","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,18]]},"article-number":"1327871"}}