External Validation of the STONE Score, a Clinical Prediction Rule for Ureteral Stone: An Observational Multi-institutional Study

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• 作者：Ralph C. Wang ; MD^a ; ^{ralph.wang@ucsf.edu" class="auth_mail" title="E-mail the corresponding author} ; ; Robert M. Rodriguez ; MD^a ; Michelle Moghadassi ; MPH^b ; Vicki Noble ; MD^d ; John Bailitz ; MD^e ; Mike Mallin ; MD^f ; Jill Corbo ; MD ; RDMS^g ; Tarina L. Kang ; MD^h ; Phillip Chu ; PhD^b ; Steve Shiboski ; PhD^c ; Rebecca Smith-Bindman ; MD^b ; ^c
• 刊名：Annals of Emergency Medicine
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：67
• 期：4
• 页码：423-432.e2
• 全文大小：839 K

文摘

The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. We evaluate the STONE score in a multi-institutional cohort compared with physician gestalt and hypothesize that it has a sufficiently high specificity to allow clinicians to defer computed tomography (CT) scan in patients with suspected nephrolithiasis.

Methods

We assessed the STONE score with data from a randomized trial for participants with suspected nephrolithiasis who enrolled at 9 emergency departments between October 2011 and February 2013. In accordance with STONE predictors, we categorized participants into low-, moderate-, or high-score groups. We determined the performance of the STONE score and physician gestalt for ureteral stone.

Results

Eight hundred forty-five participants were included for analysis; 331 (39%) had a ureteral stone. The global performance of the STONE score was superior to physician gestalt (area under the receiver operating characteristic curve=0.78 [95% confidence interval {CI} 0.74 to 0.81] versus 0.68 [95% CI 0.64 to 0.71]). The prevalence of ureteral stone on CT scan ranged from 14% (95% CI 9% to 19%) to 73% (95% CI 67% to 78%) in the low-, moderate-, and high-score groups. The sensitivity and specificity of a high score were 53% (95% CI 48% to 59%) and 87% (95% CI 84% to 90%), respectively.

Conclusion

The STONE score can successfully aggregate patients into low-, medium-, and high-risk groups and predicts ureteral stone with a higher specificity than physician gestalt. However, in its present form, the STONE score lacks sufficient accuracy to allow clinicians to defer CT scan for suspected ureteral stone.