Overuse of computed tomography for mild head injury: A systematic review and meta-analysis

Maryam Saran; Morteza Arab-Zozani; Meysam Behzadifar; Mehrdad Gholami; Samad Azari; Nicola Luigi Bragazzi; Masoud Behzadifar

doi:10.1371/journal.pone.0293558

Peer Review History

Original SubmissionJune 7, 2023
12 Jul 2023 Decision Letter - Jafar Kolahi, Editor PONE-D-23-17711Overuse of computed tomography for mild head injury: a systematic review and meta-analysisPLOS ONE Dear Dr. Behzadifar, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 26 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Jafar Kolahi Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” At this time, please address the following queries: a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” c) If any authors received a salary from any of your funders, please state which authors and which funders. d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments: Please take note of the following corrections: 1. Perform a risk of bias assessment and present the results in a 'bias graph'. 2. Conduct a publication bias analysis and present the results in a 'funnel plot'. 3. Apply the trim-and-fill method to estimate potentially missing studies due to publication bias in the funnel plot and adjust the overall effect estimate accordingly. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes Reviewer #3: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear authors, The present study is a systematic review and meta-analysis on the overuse of CT scanning in mild head trauma. I appreciate the authors’ efforts for conducting this review on such an interesting and important topic. I find the manuscript generally well-written. But based on my review, there are some issues that need to be revised and addressed: - There are several grammatical errors and typos throughout your manuscript. The manuscript may benefit from English editing by a native user. - Quality assessment and risk of bias assessment are two separate concepts. - Some abbreviations in the text are not necessary: LMIC - Please elaborate further on the justification of your study. - A brief literature review is missing. - Inclusion and exclusion criteria need revision. Reviewer #2: Thank you for the opportunity to review this well conducted and thorough systematic review which addresses an important clinical issue—use of CT imaging in mild traumatic brain injury. My main concern is how overuse or inappropriate CT imaging in this group can be defined. There are a range of decision rules which can be/are recommended to be used to triage CT imaging in this group. They all balance differing sensitivities and specificities (i.e. the risk of missing a serious injury against the number of negative CT scans need to identify a rare injury) and have different inclusion criteria (e.g. the CCHR excludes anti-coagulated patients and NICE guidelines is not applicable to patient attending > 24 hours after injury). There are also patients with concurrent cognitive impairment where application of a decision rule is difficult due to chronically impaired GCS and clinical decision-making re need for imaging may differ. Based on this different decision rules are recommended for use in different settings and the USA has a more liberal approach to CT imaging than the UK where the NICE guidelines are recommended. In North America and Europe triage of CT imaging based on GCS alone would not be clinically appropriate but this may be acceptable in other setting with more limited availability of CT imaging. I think this nuance needs to be brought out in the discussion as over use is contextual and even where there is no guideline indication for imaging it still may be appropriate. Reviewer #3: The manuscript entitle “Overuse of computed tomography for mild head injury: a systematic review and meta-analysis” was interesting and showed a high rate of using CT for a mild head injury, hence it might be useful for policymakers (developing guideline). However; many revisions should be done, particularly in the method and the result parts. Please see the attached file. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Carl Marincowitz Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Review.docx https://doi.org/10.1371/journal.pone.0293558.r001
Revision 1
14 Aug 2023 Author Response Dear editor I wanted to take a moment to express my sincere gratitude for your valuable comments and feedback on my manuscript for the journal. Your thoughtful and constructive input has helped to significantly improve the quality and clarity of the manuscript. I appreciate the time and effort that you put into reviewing the manuscript and providing such insightful comments. As you may be aware, we have carefully considered your feedback and have provided responses to each of the comments raised by the reviewers. Your expertise and attention to detail have been invaluable in helping to shape the final version of the manuscript. We hope that the revised manuscript meets the required standards and addresses all of your concerns. Thank you once again for your dedication to the peer review process and for your contributions to the advancement of scientific knowledge. Sincerely, Dr. Masoud Behzadifar ======================= Additional Editor Comments: Please take note of the following corrections: 1. Perform a risk of bias assessment and present the results in a 'bias graph'. Thank you so much for your comment. We resvised and done. 2. Conduct a publication bias analysis and present the results in a 'funnel plot'. Thank you so much for your comment. We resvised and done. 3. Apply the trim-and-fill method to estimate potentially missing studies due to publication bias in the funnel plot and adjust the overall effect estimate accordingly. Thank you so much for your comment. We resvised and done. Reviewer #1: Dear authors, The present study is a systematic review and meta-analysis on the overuse of CT scanning in mild head trauma. I appreciate the authors’ efforts for conducting this review on such an interesting and important topic. I find the manuscript generally well-written. But based on my review, there are some issues that need to be revised and addressed: - There are several grammatical errors and typos throughout your manuscript. The manuscript may benefit from English editing by a native user. Thank you so much for your comment. We resvised and done. - Quality assessment and risk of bias assessment are two separate concepts. Thank you so much for your comment. We resvised and done. - Some abbreviations in the text are not necessary: LMIC. Thank you so much for your comment. We resvised and done. - Please elaborate further on the justification of your study. Thank you so much for your comment. We resvised and done. - Inclusion and exclusion criteria need revision. Thank you so much for your comment. We resvised and done. Reviewer #2: Thank you for the opportunity to review this well conducted and thorough systematic review which addresses an important clinical issue—use of CT imaging in mild traumatic brain injury. My main concern is how overuse or inappropriate CT imaging in this group can be defined. There are a range of decision rules which can be/are recommended to be used to triage CT imaging in this group. They all balance differing sensitivities and specificities (i.e. the risk of missing a serious injury against the number of negative CT scans need to identify a rare injury) and have different inclusion criteria (e.g. the CCHR excludes anti-coagulated patients and NICE guidelines is not applicable to patient attending > 24 hours after injury). There are also patients with concurrent cognitive impairment where application of a decision rule is difficult due to chronically impaired GCS and clinical decision-making re need for imaging may differ. Based on this different decision rules are recommended for use in different settings and the USA has a more liberal approach to CT imaging than the UK where the NICE guidelines are recommended. In North America and Europe triage of CT imaging based on GCS alone would not be clinically appropriate but this may be acceptable in other setting with more limited availability of CT imaging. I think this nuance needs to be brought out in the discussion as over use is contextual and even where there is no guideline indication for imaging it still may be appropriate. Thank you so much for your comment. We resvised and done. Reviewer #3: The manuscript entitle “Overuse of computed tomography for mild head injury: a systematic review and meta-analysis” was interesting and showed a high rate of using CT for a mild head injury, hence it might be useful for policymakers (developing guideline). However; many revisions should be done, particularly in the method and the result parts. Please see the attached file. The manuscript entitle “Overuse of computed tomography for mild head injury: a systematic review and meta-analysis” was interesting and showed a high rate of using CT for a mild head injury, hence it might be useful for policymakers (developing guideline). However; many revisions should be done, particularly in the method and the result parts. Title: - Abstract 1. Write it according to PRISMA 2020 for Abstracts Checklist (many revision are needed). Thank you so much for your comment. We write abstract according PRISMA 2020. 2. Apply the other comments of text, if applicable. Thank you so much for your comment. We resvised and done. Keywords 1. Write it based on MeSH. Thank you so much for your comment. We resvised keywords based MeSH. Introduction 1. This part was lengthy and needs some revision. Thank you so much for your comment. We shorten it. Introduction, 2nd paragraph 1. The authors wrote about the management and consequence of the trauma. While the main aim of the study was the diagnosis. Delete it. Thank you so much for your comment. We deleted. Introduction, 3rd and 4th paragraphs 1. Mix these paragraphs and summarize them. Thank you so much for your comment. We mixed paragraphs. Introduction, 5th paragraphs “as reported in studies conducted across different countries” in the aim part: I think this issue was not the main aim of your studies. Indeed, there were no subgroups regarding the region. Thank you so much for your comment. We analyzed based region and added in the text. Method This part needs many revisions and responses. See the comments, please. 1. Certainty (quality) of evidence should conduct. Thank you so much for your comment. We revised and done. 2. A table of findings should be added. Thank you so much for your comment. We added. Protocol and Registration 1. Any deviation should mention here. For example: review question#2: “What is the pooled prevalence of computed tomography overuse for mild head injury based on region?” I did not find any subgroup regarding the region. Thank you so much for your comment. We analyzed based region and added in the text. Study Design: 1. I could not find the design of study in this paragraph. Thank you so much for your comment. We deleted this phrase. 2. For PRISMA 2020 Checklist, you should report the page in the checklist in the supplementary file. Thank you so much for your comment. We added number pages. 3. Add the PRISMA 2020 for Abstracts Checklist in the supplementary file too. Thank you so much for your comment. We added PRISMA for abstract in the supplementary. Search Strategy and Selection Criteria 1. Why did the author set a time limitation (January 2000)? Thank you so much for your comment. We revised in text (from inception until April 1, 2023). 2. Add the page of the appendix. Thank you so much for your comment. We added number pages 3. “two team”. Add the initial name of the researchers. Thank you so much for your comment. We added. 4. “to find additional studies”. Delete it. Thank you so much for your comment. We deleted. 5. "studies were published in peer-reviewed journals" was one of the inclusion criteria. Please explain that, while you should have considered the published article, you searched gray literature. More details should be added around gray literature. Thank you so much for your comment. We revised. Eligibility Criteria 1. When some data were missed/ full texts were unavailable, it should be supposed to contact the corresponding author. Please explain why the author did not contact the corresponding authors. Thank you so much for your comment. We did this case and added in text. 2. “those published as reviews”. Delete it. Previously it was mentioned that the observational study designs were included. Thank you so much for your comment. We deleted. 3. It is unclear whether the authors consider or not considered unpublished records. Thank you so much for your comment. We added. 4. “intervention studies, or studies in languages other than English.” The type and language limitations were mentioned, previously. Thank you so much for your comment. We deleted. Data Collection 1. “two author teams extracted information”. Add the initial name of the researchers. Thank you so much for your comment. We added. 2. Gender ratio or number? Thank you so much for your comment. We added number. 3. “criteria for CT scan performance, and prevalence of overuse”. I could not find these variables in the table. Thank you so much for your comment. We dded in Table 1. 4. “resolved by a senior researcher”. Add the initial name of the researchers. Thank you so much for your comment. We added. 5. “a third reviewer was introduced”. Add the initial name of the researcher. Thank you so much for your comment. We added. 6. “designed by the authors' group”. All authors or some of them (if some, add the initial name of them). Thank you so much for your comment. We added. Risk of Bias of Individual Studies 7. How many authors did that? Add the initial name of them. Thank you so much for your comment. We added. Statistical Analysis 8. "inverse variance" and "Dersimonian-Laird" are two different models. Why did the authors use two different computations? Thank you so much for your comment. We cahnged. 1. Why you did not conduct a sensitivity analysis by omitting high RoB studies? What was the benefit of conducting a RoB assessment? Thank you so much for your comment. We cahnged this section. 2. mean of age. Thank you so much for your comment.We changed. 3. I recommend conducting quantitative publication measurement (Regression-based Egger/Harbord/Peters test). In addition, funnel plots could be add in supplementary file. Thank you so much for your comment. We added and changed. Results 1. Many revisions are needed. Study Selection 1. “and 45 were excluded.” According to PRISMA checklist 2020, 16b: Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded. Hence, cite the articles and explain the reason for the exclusion in a table in the supplementary file. Thank you so much for your comment. We added in the supplementary file. 2. “Figure 1”. Use PRISMA 2020 flow diagram for new systematic. Thank you so much for your comment. We changed based PRISMA 2020 flow diagram. Study Characteristics 9. “Out of a total of 8 articles, two were done in Iran. The rest of the countries had assigned one article each, and”. Delete it. Thank you so much for your comment. We deleted. 10. Add more details regard the “criteria for CT scan performance” and “criteria for diagnosing acute head injury”. Thank you so much for your comment. All patients had mild acute head injury. Risk of Bias 11. The visualization cloud makes this part easier for the reader. Thank you so much for your comment. We added figures in the text. 12. More details are needed: for example, which domain was high risk among the studies? Add results for each study and each domain. Thank you so much for your comment. We added. 13. “The risk of bias of the included studies was assessed through the use of the NOS checklist.” Delete it. Thank you so much for your comment. We deleted.. 1. “One study received a score of 6, two studies scored 7, four studies scored 8,” Cite the studies. Thank you so much for your comment. We added cite. Synthesis of Results 1. “using a random model”. Delete it. Thank you so much for your comment. We deleted. 2. Write the I2 in the bracket and delete “This was observed with I2=99%”. Hence, the correct from is [95% CI: 16-43; I2=99%]. Thank you so much for your comment. We deleted and corrected. 3. “Figure 2”. Delete this figure. Figure 3 was enough. Thank you so much for your comment. We changed. 4. “To ensure the robustness of the sensitivity analysis, the impact of each study was consistent before and after the analysis. Furthermore, the effect of study order was examined through cumulative meta-analysis.” Here, you should report the result here. Thank you so much for your comment. We done this comment. 5. “Here, you should report the result here”. In the method part, any subgroup should be mentioned. Thank you so much for your comment. We done this comment. 6. Add I2 when reporting 95% CI. Thank you so much for your comment. We done this comment. 7. “Accordance clinical decision rules”. In the method part, any subgroup should be mentioned. These variables are also not reported in data extraction table 1. Thank you so much for your comment. We done this comment. Comparison of criteria used in included studies 8. This part was not clear. In addition, neither declare in the aim nor method part. I think it should be deleted. Thank you so much for your comment. We deleted. Meta-regression (last paragraph of result) 1. “This part was not clear. In addition, neither declare in the aim nor method part. I think it should be deleted.” Delete it. Thank you so much for your comment. We deleted. 2. “The results are presented in Table 2”. The results of meta-regression are presented in Table Thank you so much for your comment. We deleted. Discussion 1. Some parts of the discussion should reassess after the method and result revisions. Discussion, 1st paragraph 1. “However, the rate range reported in the 8 studies included in the final analysis varied.” Delete it. Thank you so much for your comment. We deleted. 2. “It is important to note that differences in study populations, including age, gender, comorbidities, and severity of head injury, may have influenced the rate of overuse observed in our study”. Some of these variables were available in your studies and could be checked (or checked) through mete-regression to support your discussion. Thank you so much for your comment. We deleyed the meta-regression based reviewer comment. 3. “Furthermore, our study found that the rate of overuse of CT scans varied between countries,” you could do a subgroup based on country to support your discussion. Thank you so much for your comment. We analyzed base country and added in the results. Discussion, 2nd paragraph 1. “Glasgow Coma Scale (GCS)”. Delete “Glasgow Coma Scale”. Previously you define this abbreviation. Thank you so much for your comment. We deleted. Discussion, 3rd paragraph: - Discussion, 4th paragraph 1. It needs to reassess after revision or the author's response. Discussion, 5th paragraph 1. First line, “our study found that”. Delete it. Thank you so much for your comment. We deleted. Discussion, 6th paragraph: - Discussion, 7th paragraph 1. This part (policies were suggested) was a good point of this study. Strengths and Limitations 1. Add more strength regarding the work. Thank you so much for your comment. We added and changed. 2. How did the authors deal with heterogeneity? Thank you so much for your comment. We used subgroup analysis. Conclusion 1. “Based on the findings of our meta-analysis, it can be concluded that”. Delete it. Thank you so much for your comment. We deleted. 2. “for mild head injury patients”. Delete it. Thank you so much for your comment. We deleted. 3. “Future research should aim to identify barriers and facilitators to the implementation of such guidelines, and to evaluate the impact of interventions aimed at reducing excessive CT scan use in mild head injury patients.” Delete it. Thank you so much for your comment. We deleted. Data Availability 1. Data relevant to the meta-analysis were not in the supplementary file. Thank you so much for your comment. We added file. Abbreviations 1. “CI: confidence intervals”. Write it as “CI: Confidence intervals”. Check all words. Thank you so much for your comment. We checked and revised. Funding 1. “The author(s) received no financial support for the research, authorship, and/or publication of this article.” In CRD, Lorestan University of Medical Sciences was mentioned for funding. Transparency is very important for each study. Thank you so much for your comment. We changed this in the CRD. Author Contributions 2. Some authors were added to the paper while their names were not in the CRD protocol. I recommend, if any deviation from protocol was done, revise the protocol in CRD. Thank you so much for your comment. We changed this in the CRD. 3. While the authors declare "no funding", what were they mean by mentioning resources?. Thank you so much for your comment. We changed this in the CRD. 1. References:- Table 1 1. In “First author” column: Delete the initial names. Thank you so much for your comment. We deleted. 2. “Glasgow coma scale”. Write it “Glasgow Coma Scale”. Thank you so much for your comment. We revised. 3. “Age”. Add the value of this variable. Thank you so much for your comment. We revised. 4. “NA”. Define the NA in the footnote. Thank you so much for your comment. We revised. 5. “the Pediatric Emergency Care Applied Research Network (PECARN)” in footnote: write as “PECARN: the Pediatric Emergency Care Applied Research Network”. Thank you so much for your comment. We revised. Table 2: - Figure 1 6. Use PRISMA 2020 flow diagram. Thank you so much for your comment. We revised. 7. What was the difference between the two last lines in excluded box? Thank you so much for your comment. We revised. Figure 2 8. Delete this figure. Figure 3 was enough. Thank you so much for your comment. We deleted. Figure 3. 1. Delete the initial names. Thank you so much for your comment. We deleted. Figure 4, 5 and 6 1. As previously mentioned, this part (Comparison of criteria used in included studies) was not clear. Thank you so much for your comment. We deleted. Supporting Information Search strategy 1. Add “PRESS Guideline — Search Submission & Peer Review Assessment” PRISMA Checklist 9. For PRISMA 2020 Checklist, you should report the page in the checklist in the supplementary file. Thank you so much for your comment. We revised. 10. Add the PRISMA 2020 for Abstracts Checklist in the supplementary file too. Thank you so much for your comment. We revised. Attachments Attachment Submitted filename: Response lettet to reviewers.docx https://doi.org/10.1371/journal.pone.0293558.r002
30 Aug 2023 Decision Letter - Jafar Kolahi, Editor PONE-D-23-17711R1Overuse of computed tomography for mild head injury: a systematic review and meta-analysisPLOS ONE Dear Dr. Behzadifar, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Oct 14 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Jafar Kolahi Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Please add sensitivity test, Baujat test and related plots. [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0293558.r003
Revision 2
30 Aug 2023 Author Response Dear editor I wanted to take a moment to express my sincere gratitude for your valuable comments and feedback on my manuscript for the journal. Your thoughtful and constructive input has helped to significantly improve the quality and clarity of the manuscript. I appreciate the time and effort that you put into reviewing the manuscript and providing such insightful comments. As you may be aware, we have carefully considered your feedback and have provided responses to each of the comments raised by the reviewers. Your expertise and attention to detail have been invaluable in helping to shape the final version of the manuscript. We hope that the revised manuscript meets the required standards and addresses all of your concerns. Thank you once again for your dedication to the peer review process and for your contributions to the advancement of scientific knowledge. Sincerely, Dr. Masoud Behzadifar ======================= Additional Editor Comments: Please take note of the following corrections: Please add sensitivity test, Baujat test and related plots. Thank you so much for your comment. We added Baujat test and sensitivity test and related plots (Figure 4 and Figure 5). Attachments Attachment Submitted filename: Response to the reviewers.docx https://doi.org/10.1371/journal.pone.0293558.r004
20 Sep 2023 Decision Letter - Jafar Kolahi, Editor PONE-D-23-17711R2Overuse of computed tomography for mild head injury: a systematic review and meta-analysisPLOS ONE Dear Dr. Behzadifar, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 04 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Jafar Kolahi Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Please add citations to the table of included articles. [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0293558.r005
Revision 3
20 Sep 2023 Author Response Dear editor I wanted to take a moment to express my sincere gratitude for your valuable comments and feedback on my manuscript for the journal. Your thoughtful and constructive input has helped to significantly improve the quality and clarity of the manuscript. I appreciate the time and effort that you put into reviewing the manuscript and providing such insightful comments. As you may be aware, we have carefully considered your feedback and have provided responses to each of the comments raised by the reviewers. Your expertise and attention to detail have been invaluable in helping to shape the final version of the manuscript. We hope that the revised manuscript meets the required standards and addresses all of your concerns. Thank you once again for your dedication to the peer review process and for your contributions to the advancement of scientific knowledge. Sincerely, Dr. Masoud Behzadifar ======================= Additional Editor Comments: Please add citations to the table of included articles. Thank you so much for your comment. We added references to the table of included articles. Attachments Attachment Submitted filename: Response to the reviewers.docx https://doi.org/10.1371/journal.pone.0293558.r006
5 Oct 2023 Decision Letter - Jafar Kolahi, Editor PONE-D-23-17711R3Overuse of computed tomography for mild head injury: a systematic review and meta-analysisPLOS ONE Dear Dr. Behzadifar, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 19 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Jafar Kolahi Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Please extend figure legends. [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0293558.r007
Revision 4
6 Oct 2023 Author Response Dear Dr. Jafar Kolahi Academic Editor of the PLOS ONE I would like to express my sincere gratitude for your time and valuable feedback on my manuscript submitted to PLOS ONE. I appreciate the thorough review of my work and the opportunity to revise it in accordance with your comments and suggestions. I have carefully considered of your comment and have made the necessary revisions to improve the quality and clarity of the manuscript. Below, I address each of your points and provide an explanation of the changes made. I believe that the revisions have significantly strengthened the manuscript and have addressed the concerns raised during the initial review. Additionally, I have taken care to ensure that the manuscript complies with the journal's guidelines and formatting requirements. Please find attached the revised manuscript, along with a marked-up version highlighting the changes made. I hope that you will find these revisions satisfactory, and they meet the standards of the PLOS ONE Journal. With best wishes Masoud Behzadifar Correspondence author ********************************************** Additional Editor Comments: Please extend figure legends. Thank you for your constructive feedback and your valuable suggestion to extend the figure legends in our manuscript. In response to your comment, we have revised the figure legends for all figures in the manuscript. We have expanded upon the information provided in the legends to provide more context and explanation of the key findings and elements depicted in each figure. These extended figure legends now provide a more comprehensive description of the data, methodology, and results associated with each figure. Attachments Attachment Submitted filename: Response to the reviewers-4.docx https://doi.org/10.1371/journal.pone.0293558.r008
16 Oct 2023 Decision Letter - Jafar Kolahi, Editor Overuse of computed tomography for mild head injury: a systematic review and meta-analysis PONE-D-23-17711R4 Dear Dr. Behzadifar, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jafar Kolahi Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0293558.r009
Formally Accepted
3 Jan 2024 Acceptance Letter - Jafar Kolahi, Editor PONE-D-23-17711R4 PLOS ONE Dear Dr. Behzadifar, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Jafar Kolahi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0293558.r010

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .