Methodology Score: 2/5
Usefulness Score: 2/5
Questions and Methods: This cohort study examined the rate of traumatic ICH on initial CT head for patients taking an anticoagulant or antiplatelet after sustaining a ground-level fall.
Findings: Antiplatelets had a rate of tICH of 4.3% compared to anticoagulants which had a rate of 1.7%. Aspirin alone had a tICH rate of 4.6%.
Limitations: This study had a disproportionate number of patients on antiplatelet agents, lacked patients on newer agents, included all CT abnormalities (not just clinical important), and did not apply Canadian CT head rule to the low dose ASA group.
Interpretation: Currently we still do not have evidence for who needs a CT head in patients on antiplatelets (aside from low dose ASA) and anticoagulants who sustain a ground-level fall.
Prospective cohort studies should be as they say “prospective”. However, there are many variations of these in the medical literature. Some are prospectively identified cases with retrospective data abstraction. This may be appropriate, if all data are reliably recorded (e.g. sex, age, CT done), however, if collecting clinical data, these data are much less reliably recorded. This may then become a medical record review/historical cohort study, with all the limitations and missing data associated with this study design.
By: Dr. Jeff Perry