We recently read with great interest the article ‘Sex differences in the epidemiology of spontaneous and traumatic cervical artery dissections’.1 The authors conducted a retrospective analysis of 144 patients with cervical artery dissection (CeAD), revealing important sex-related differences that offer valuable insights for clinicians. Despite the quality of the work, we believe the study has several limitations that should be addressed.
First, traumatic CeAD and spontaneous CeAD are conventionally considered distinct mechanisms.2 Combining them in a single analysis may compromise the precision and reliability of the conclusions. Moreover, several other factors contribute to a patient’s risk of CeAD, including connective tissue disorders, acquired conditions such as infection and hypertension, and anatomical aberrations like elongated styloid processes.3 We recommend further stratifying and analysing the data to address these factors.
Another issue pertains to the statistical methods employed. While the methods themselves are appropriate, the small sample size and the multiple comparisons increase the risk of false positives. We suggest applying corrections like the Bonferroni adjustment to mitigate this risk and strengthen the robustness of the results.
In conclusion, while the study provides valuable insights, we feel that its persuasiveness is limited by these issues, and additional research is needed to validate the findings.
Ethics statements
Patient consent for publication
Ethics approval
Not applicable.
Footnotes
Contributors The conception was first raised and designed by GW. XZ was the major contributor in drafting the manuscript. All authors read and approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
