{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:13:05Z","timestamp":1787015585623,"version":"build-2736575974"},"reference-count":61,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Several clinical decision rules have been devised to guide head computed tomography (CT) use in patients with minor head injuries, but none have been validated in patients 65\u2009years or older. We aimed to derive and validate a head injury clinical decision rule for older adults.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis of an existing dataset of consecutive emergency department (ED) patients &gt;65\u2009years old with blunt head trauma. The main predictive outcomes were significant intracranial injury and Need for Neurosurgical Intervention on CT. The secondary outcomes also considered in the model development and validation were All Injuries and All Intracranial Injuries. Predictor variables were identified using multiple variable logistic regression, and clinical decision rule models were developed in a split\u2010sample derivation cohort and then tested in an independent validation cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 5776 patients, 233 (4.0%) had significant intracranial injury and an additional 104 (1.8%) met CT criteria for Need for Neurosurgical Intervention. The best performing model, the Florida Geriatric Head Trauma CT Clinical Decision Rule, assigns points based on several clinical variables. If the points totaled 25 or more, a CT scan is indicated. The included predictors were arrival via Emergency Medical Services (+30 points), Glasgow Coma Scale (GCS) &lt;15 (+20 points), GCS &lt;14 (+50 points), antiplatelet medications (+17 points), loss of consciousness (+16 points), signs of basilar skull fracture (+50 points), and headache (+20 points). Utilizing this clinical decision rule in the validation cohort, a point total \u226525 had a sensitivity and specificity of 100.0% (95% CI: 96.0\u2013100) and 12.3% (95% CI: 10.9\u201313.8), respectively, for significant intracranial injury and Need for Neurosurgical Intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The Florida Geriatric Head Trauma CT Clinical Decision Rule has the potential to reduce unnecessary CT scans in older adults, without compromising safe emergency medicine practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.19057","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T12:48:31Z","timestamp":1720010911000},"page":"2738-2751","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The Florida Geriatric Head Trauma CT Clinical Decision Rule"],"prefix":"10.1111","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4777-6343","authenticated-orcid":false,"given":"Richard D.","family":"Shih","sequence":"first","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"},{"name":"Depatment of Emergency Medicine Delray Medical Center  Delray Beach Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3824-6308","authenticated-orcid":false,"given":"Scott M.","family":"Alter","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"},{"name":"Depatment of Emergency Medicine Delray Medical Center  Delray Beach Florida USA"},{"name":"Depatment of Emergency Medicine Bethesda Hospital East  Boynton Beach Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4520-2007","authenticated-orcid":false,"given":"Mike","family":"Wells","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8408-3189","authenticated-orcid":false,"given":"Joshua J.","family":"Solano","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"},{"name":"Depatment of Emergency Medicine Delray Medical Center  Delray Beach Florida USA"},{"name":"Depatment of Emergency Medicine Bethesda Hospital East  Boynton Beach Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2729-995X","authenticated-orcid":false,"given":"Gabriella","family":"Engstrom","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9729-2676","authenticated-orcid":false,"given":"Lisa M.","family":"Clayton","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"},{"name":"Depatment of Emergency Medicine Delray Medical Center  Delray Beach Florida USA"},{"name":"Depatment of Emergency Medicine Bethesda Hospital East  Boynton Beach Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0073-6961","authenticated-orcid":false,"given":"Patrick G.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"},{"name":"Depatment of Emergency Medicine Delray Medical Center  Delray Beach Florida USA"},{"name":"Depatment of Emergency Medicine Bethesda Hospital East  Boynton Beach Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9427-8710","authenticated-orcid":false,"given":"Lara","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Memorial Healthcare System  Hollywood Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Lottenberg","sequence":"additional","affiliation":[{"name":"Charles E. Schmidt College of Medicine Florida Atlantic University  Boca Raton Florida USA"},{"name":"Department of Surgery St. Mary's Medical Center  West Palm Beach Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph G.","family":"Ouslander","sequence":"additional","affiliation":[{"name":"Charles E. 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