{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T13:29:01Z","timestamp":1747834141819,"version":"3.40.5"},"reference-count":14,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,4,14]],"date-time":"2019-04-14T00:00:00Z","timestamp":1555200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aims of the present study were to derive and validate a clinical decision rule (CDR) to rule out the need for computed tomography of the brain (CTB) in non\u2010traumatic patients who present to the ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective review of non\u2010traumatic patients who presented to the EDs in two urban hospitals and received CTB from January 2014 to December 2016. Data from one hospital were used to develop a CDR for clinically significant CTB findings. Clinically significant CTB findings were defined as acute infarction, intracranial neoplasm, intracranial haemorrhage, acute hydrocephalus, cerebral oedema and intracranial infection. Patients from another hospital were used as a validation cohort to evaluate the CDR and compare it to four previously derived CDRs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 5296 cases in the derivation cohort, with 345 (6.5%) clinically significant CTB findings. Identified risk factors were: focal neurological deficit (adjusted odds ratio [OR] 3.4, 95% confidence interval [CI] 2.6\u20134.4), Glasgow Coma Scale &lt;15 (adjusted OR 3.5, 95% CI 2.6\u20134.6), history of malignancy (adjusted OR 3.2, 95% CI 2.4\u20134.2), nausea and\/or vomiting (adjusted OR 1.6, 95% CI 1.1\u20132.1), headache (adjusted OR 1.1, 95% CI 0.9\u20131.5) and coagulopathy (adjusted OR 9.2, 95% CI 2.1\u201341.5). These criteria and four pre\u2010existing CDRs were applied to the validation cohort of 5098 patients from the second hospital, which had 338 (6.6%) clinically significant CTB findings. Our criteria were found to have a sensitivity of 99.7% (95% CI 99.1\u2013100.0) and a specificity of 11.0% (95% CI 10.1\u201311.9). The risk of having a clinically significant CTB finding is 0.3% if patients do not meet any of the criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The CDR derived in the present study achieved the highest sensitivity and a moderate specificity when compared with four other pre\u2010existing CDRs for non\u2010traumatic brain injury patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1742-6723.13292","type":"journal-article","created":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T01:35:45Z","timestamp":1555292145000},"page":"974-981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical decision rule for non\u2010traumatic computed tomography of the brain"],"prefix":"10.1111","volume":"31","author":[{"given":"Joshua M","family":"Scott\u2010King","sequence":"first","affiliation":[{"name":"Faculty of Medicine The University of New South Wales  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Tieu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The University of New South Wales  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela L","family":"Chiew","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The University of New South Wales  Sydney New South Wales Australia"},{"name":"Department of Emergency Medicine, Clinical Toxicology Unit Prince of Wales Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Lui","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine The Sutherland Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0876-8113","authenticated-orcid":false,"given":"Katharine A","family":"Kirby","sequence":"additional","affiliation":[{"name":"Discipline of Pharmacology, School of Medical Sciences The University of Sydney  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0083-282X","authenticated-orcid":false,"given":"Betty S","family":"Chan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine The University of New South Wales  Sydney New South Wales Australia"},{"name":"Department of Emergency Medicine, Clinical Toxicology Unit Prince of Wales Hospital  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,4,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2009.440"},{"key":"e_1_2_6_3_1","unstructured":"England N.Diagnostic Imaging Dataset. 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