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Ann Emerg Med. 2016 Apr;67(4):423-432.e2. doi: 10.1016/j.annemergmed.2015.08.019. Epub 2015 Oct 3.

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

Author information

1
Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA. Electronic address: ralph.wang@ucsf.edu.
2
Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA.
3
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA.
4
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
5
Department of Emergency Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL.
6
Division of Emergency Medicine, University of Utah, Salt Lake City, UT.
7
Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY.
8
Department of Emergency Medicine, Los Angeles County at the University of Southern California, Los Angeles, CA.
9
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
10
Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.

Abstract

STUDY OBJECTIVE:

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.

PMID:
26440490
PMCID:
PMC4808407
DOI:
10.1016/j.annemergmed.2015.08.019
[Indexed for MEDLINE]
Free PMC Article

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