Hernandez Natalia, Song Yan, Noble Vicki E, Eisner Brian H
Departments of Urology and Emergency Medicine, GRB 1102, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
World J Urol. 2016 Oct;34(10):1443-6. doi: 10.1007/s00345-016-1760-3. Epub 2016 Jan 16.
The ability to objectively predict which emergency department patients are likely to have a ureteral stone may aid in cost-effectiveness and patient-centered diagnostic imaging decisions. We performed an external validation of the STONE score, a clinical prediction rule for the presence of uncomplicated ureteral stones in emergency department patients developed at Yale University School of Medicine.
Five hundred thirty-six (536) consecutive patients evaluated in an urban tertiary care emergency department for the possible diagnosis of ureteral stone were retrospectively reviewed. The STONE score uses five factors (gender, duration of pain, race, nausea/vomiting, erythrocytes on urine dipstick) to categorize patients into low, medium, and high probability of having a ureteral stone. The total STONE score risk is 0-13 and divided into three groups: low risk = 0-5, moderate risk = 6-9, and high risk = 10-13.
Of the 536 patients evaluated for suspected ureteral stone, 257 (47.8 %) had a ureteral stone. Mean patient age was 45.9 years (SD 16.3), and gender distribution was 43.9 % female and 56.1 % male. Distribution of STONE score risk was 24.1 % low, 48.1 % moderate, and 27.7 % high. Diagnosis of ureteral stone by STONE score risk was 14 % for low-risk group, 48.3 % for moderate-risk group, and 75.8 % for high-risk group. This distribution is consistent with internal validation at Yale University School of Medicine, where values were 8.3-9.2 % for low risk, 51.3-51.6 % for moderate risk, and 88.6-89.6 % for high risk.
Our study validates the use of the STONE clinical score to categorize patients as low, moderate, and high risk for ureteral stone. This could help guide development of clinical decision rules for diagnostic studies and imaging in the future.
客观预测哪些急诊科患者可能患有输尿管结石的能力，可能有助于做出具有成本效益且以患者为中心的诊断成像决策。我们对STONE评分进行了外部验证，这是耶鲁大学医学院制定的一项针对急诊科患者单纯性输尿管结石存在情况的临床预测规则。
回顾性分析了在一家城市三级医疗急诊科连续评估的536例可能诊断为输尿管结石的患者。STONE评分使用五个因素（性别、疼痛持续时间、种族、恶心/呕吐、尿试纸条上的红细胞）将患者分为输尿管结石低、中、高概率组。STONE总分风险为0至13分，分为三组：低风险=0至5分，中度风险=6至9分，高风险=10至13分。
在536例接受疑似输尿管结石评估的患者中，257例（47.8%）患有输尿管结石。患者平均年龄为45.9岁（标准差16.3），性别分布为女性43.9%，男性56.1%。STONE评分风险分布为低风险24.1%，中度风险48.1%，高风险27.7%。低风险组通过STONE评分风险诊断输尿管结石的比例为14%，中度风险组为48.3%，高风险组为75.8%。这种分布与耶鲁大学医学院的内部验证结果一致，低风险组的比例为8.3%至9.2%，中度风险组为51.3%至51.6%，高风险组为88.6%至89.6%。
我们的研究验证了使用STONE临床评分将患者分类为输尿管结石低、中、高风险的方法。这有助于指导未来诊断研究和成像临床决策规则的制定。
