{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:47:07Z","timestamp":1792100827080,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001505","name":"Health Research Council of New Zealand","doi-asserted-by":"publisher","award":["22\/031"],"award-info":[{"award-number":["22\/031"]}],"id":[{"id":"10.13039\/501100001505","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008247","name":"University of Otago","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008247","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical biomarkers are an objective test with the potential to improve CT head decision pathways by better risk stratifying patients and supporting Emergency department (ED) physician gestalt. Understanding variations in diagnostic approach, risk tolerance and the perceived need to upgrade guidelines and where will help inform further development of novel TBI pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study explored senior emergency physician perspectives regarding current clinical pathways and the potential use of clinical biomarkers as a rule\u2010out test for intracranial pathology in head\u2010injured patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This descriptive qualitative design study uses data from 11 individual senior ED clinician interviews. Thematic analysis was then performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The three main themes identified were safe practice and clinical decision\u2010making, resources and logistics and challenges of changing practice. While most clinicians reported easy access to CT head scans, most also reported that waiting for CTs was associated with delays. The majority believed that at least some patient groups were over\u2010investigated in this context. Potential benefits of a rule\u2010out biomarker were viewed positively. However, risk tolerance for missed findings was low, ranging from 0.2% to 1%\u20132%. A strong evidence base demonstrating a biomarker performed with this precision was viewed by most as essential prior to its use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Senior ED physicians viewed the potential inclusion of biomarkers in CT head guidelines favorably, particularly concerning decision support in low\u2010risk head injuries. However, the lack of expert consensus or strong evidence demonstrating high diagnostic precision in comparable emergency care models limits their introduction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1742-6723.70144","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T07:50:28Z","timestamp":1759477828000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Exploring Senior Emergency Physicians' Perspectives on the Inclusion of Clinical Biomarkers in Clinical Decision Rules for\n                    <scp>CT<\/scp>\n                    Head Use in Patients With Suspected\n                    <scp>Traumatic Brain Injury<\/scp>"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1305-0325","authenticated-orcid":false,"given":"Alice","family":"Rogan","sequence":"first","affiliation":[{"name":"Department of Surgery and Critical Care, Te Tari H\u0101parapara, Te Tari Wh\u0101omoomo University of Otago (Wellington), \u014ct\u0101kou Whakaihu Waka  Wellington New\u00a0Zealand"},{"name":"Wellington Emergency Department. Te Pae Tiaki Wellington Regional Hospital  Wellington New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Larsen","sequence":"additional","affiliation":[{"name":"Department of Surgery and Critical Care, Te Tari H\u0101parapara, Te Tari Wh\u0101omoomo University of Otago (Wellington), \u014ct\u0101kou Whakaihu Waka  Wellington New\u00a0Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30415-0"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-034494"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2018.5.37293"},{"key":"e_1_2_11_5_1","first-page":"99","volume-title":"Application of NICE or SNC Guidelines May Reduce the Need for Computerized Tomographies in Patients With Mild Traumatic Brain Injury: A Retrospective Chart Review and Theoretical Application of Five Guidelines","author":"Svensson S.","year":"2019"},{"key":"e_1_2_11_6_1","first-page":"22","volume-title":"Computed Tomography Use for Adults With Head Injury: Describing Likely Avoidable Emergency Department Imaging Based on the Canadian CT Head Rule","author":"Sharp A. 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