Abstract：
OBJECTIVE: To derive a clinical decision rule to exclude cerebral venous sinus thrombosis (CVST) in the ED. A secondary aim was to derive a rule that incorporated clinical parameters and the non-contrast CT brain.
METHODS: Single-centre, retrospective cohort study. Patients suspected of CVST were identified from the radiology database for CT/MR venograms. Clinical features included in the rule were determined by literature review. The presence of these features in participants was determined by chart review. Variables were tested for univariate association with CVST using logistic regression. Variable selection was accomplished using a forward-stepwise process, calculating the sensitivity/specificity of a rule containing the variable of most significance, then repeating the process after adding the next most significant variable.
RESULTS: Forty-five out of 912 participants had confirmed CVST. The primary clinical rule was answering \'no\' to all the following: any prothrombotic risk factor, age ≥54 years, confusion: sensitivity 95.6% (95% confidence interval [CI] 84.9-99.5%), specificity 40.9% (95% CI 37.6-44.2%), negative predictive value 99.4% (95% CI 97.9-99.9%) and positive predictive value 7.7% (95% CI 7.1-8.3%). The rule classified 39.5% of participants as CVST ruled out. The rule incorporating the non-contrast CT brain was answering \'no\' to all the following: abnormal non-contrast CT brain, any prothrombotic risk-factor, age ≥54 years, confusion: sensitivity 100.0% (95% CI 91.6-100.0%), specificity 42.0% (95% CI 38.7-45.4%), negative predictive value 100.0% (95% CI not calculated) and positive predictive value 7.8% (95% CI 7.4-8.2%). The rule classified 40.0% of participants as CVST ruled out.
CONCLUSIONS: A clinical decision rule was derived to rule out CVST. These results require validation before adoption into clinical practice.
METHODS: Single-centre, retrospective cohort study. Patients suspected of CVST were identified from the radiology database for CT/MR venograms. Clinical features included in the rule were determined by literature review. The presence of these features in participants was determined by chart review. Variables were tested for univariate association with CVST using logistic regression. Variable selection was accomplished using a forward-stepwise process, calculating the sensitivity/specificity of a rule containing the variable of most significance, then repeating the process after adding the next most significant variable.
RESULTS: Forty-five out of 912 participants had confirmed CVST. The primary clinical rule was answering \'no\' to all the following: any prothrombotic risk factor, age ≥54 years, confusion: sensitivity 95.6% (95% confidence interval [CI] 84.9-99.5%), specificity 40.9% (95% CI 37.6-44.2%), negative predictive value 99.4% (95% CI 97.9-99.9%) and positive predictive value 7.7% (95% CI 7.1-8.3%). The rule classified 39.5% of participants as CVST ruled out. The rule incorporating the non-contrast CT brain was answering \'no\' to all the following: abnormal non-contrast CT brain, any prothrombotic risk-factor, age ≥54 years, confusion: sensitivity 100.0% (95% CI 91.6-100.0%), specificity 42.0% (95% CI 38.7-45.4%), negative predictive value 100.0% (95% CI not calculated) and positive predictive value 7.8% (95% CI 7.4-8.2%). The rule classified 40.0% of participants as CVST ruled out.
CONCLUSIONS: A clinical decision rule was derived to rule out CVST. These results require validation before adoption into clinical practice.
摘要：
目的：得出排除ED中脑静脉窦血栓形成（CVST）的临床决策规则。次要目标是得出一条规则，该规则结合了临床参数和非对比CT脑。
方法：单中心，回顾性队列研究。从放射学数据库中确定了疑似CVST的患者的CT/MR静脉造影。通过文献综述确定规则中包括的临床特征。通过图表审查确定参与者中这些特征的存在。使用逻辑回归测试变量与CVST的单变量关联。变量选择是使用正向逐步过程完成的，计算包含最重要变量的规则的灵敏度/特异性，然后在添加下一个最重要的变量后重复该过程。
结果：912名参与者中有45名确认了CVST。主要临床规则是对以下所有问题回答“不”：任何血栓前危险因素，年龄≥54岁，混淆：敏感度95.6%（95%置信区间[CI]84.9-99.5%），特异性40.9%（95%CI37.6-44.2%），阴性预测值99.4%(95%CI97.9-99.9%)和阳性预测值7.7%(95%CI7.1-8.3%)。该规则将39.5%的参与者归类为CVST排除。纳入非对比CT脑的规则对以下所有问题都回答了“否”：异常非对比CT脑，任何前血栓形成的危险因素，年龄≥54岁，混淆：敏感度100.0%（95%CI91.6-100.0%），特异性42.0%（95%CI38.7-45.4%），阴性预测值100.0%(95%CI未计算)和阳性预测值7.8%(95%CI7.4-8.2%)。该规则将40.0％的参与者归类为CVST排除。
结论：得出了排除CVST的临床决策规则。这些结果在应用于临床实践之前需要验证。
方法：单中心，回顾性队列研究。从放射学数据库中确定了疑似CVST的患者的CT/MR静脉造影。通过文献综述确定规则中包括的临床特征。通过图表审查确定参与者中这些特征的存在。使用逻辑回归测试变量与CVST的单变量关联。变量选择是使用正向逐步过程完成的，计算包含最重要变量的规则的灵敏度/特异性，然后在添加下一个最重要的变量后重复该过程。
结果：912名参与者中有45名确认了CVST。主要临床规则是对以下所有问题回答“不”：任何血栓前危险因素，年龄≥54岁，混淆：敏感度95.6%（95%置信区间[CI]84.9-99.5%），特异性40.9%（95%CI37.6-44.2%），阴性预测值99.4%(95%CI97.9-99.9%)和阳性预测值7.7%(95%CI7.1-8.3%)。该规则将39.5%的参与者归类为CVST排除。纳入非对比CT脑的规则对以下所有问题都回答了“否”：异常非对比CT脑，任何前血栓形成的危险因素，年龄≥54岁，混淆：敏感度100.0%（95%CI91.6-100.0%），特异性42.0%（95%CI38.7-45.4%），阴性预测值100.0%(95%CI未计算)和阳性预测值7.8%(95%CI7.4-8.2%)。该规则将40.0％的参与者归类为CVST排除。
结论：得出了排除CVST的临床决策规则。这些结果在应用于临床实践之前需要验证。
