Fukuhara Hiroki, Ichiyanagi Osamu, Midorikawa Shinichi, Kakizaki Hiroshi, Kaneko Hisashi, Tsuchiya Norihiko
Department of Urology, Nihonkai General Hospital, 30 Akiho, Sakata, Yamagata 998-8501, Japan.
Department of Urology, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, Yamagata, Yamagata 990-9585, Japan.
Am J Emerg Med. 2017 Dec;35(12):1859-1866. doi: 10.1016/j.ajem.2017.06.023. Epub 2017 Jun 13.
The CHOKAI and STONE scores are prediction models for ureteral stones. The aims of the present study were to evaluate the diagnostic performance, to examine the optimal cut-off value, and to compare the diagnostic performance of each model.
Patients who presented to our emergency department with renal colic were considered for this prospective study. We analyzed the predictive performance of both STONE and CHOKAI scores at their optimal cut-off values, using receiver operating characteristic (ROC) curve and area under the curve (AUC), as well as sensitivity, specificity, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) at the optimal cut-off value.
Of the 96 patients who met the inclusion criteria, 79 were definitively diagnosed with ureteral stones. All patients were of Japanese descent. The AUC of the CHOKAI score was 0.971 at an optimal cut-off value of 6, showing a sensitivity of 0.911, specificity of 0.941, LR+ of 15.49, and LR- of 0.094. The AUC of the STONE score was 0.873 at an optimal cut-off value of 8, showing a sensitivity of 0.823, specificity of 0.824, LR+ of 4.662, and LR- of 0.215. The AUC of the CHOKAI score was significantly higher than that of the STONE score (p=0.010). Of the 73 patients with a CHOKAI score of ≥6, 98.6% had ureteral stones, and of the 68 patients with a STONE score of ≥8, 95.6% had ureteral stones.
The simplified CHOKAI score is a useful tool to screen for ureteral stones in patients with renal colic.
CHOKAI评分和STONE评分是输尿管结石的预测模型。本研究的目的是评估诊断性能，检查最佳临界值，并比较各模型的诊断性能。
本前瞻性研究纳入了因肾绞痛就诊于我院急诊科的患者。我们使用受试者工作特征（ROC）曲线和曲线下面积（AUC），以及最佳临界值时的敏感性、特异性、阳性似然比（LR+）和阴性似然比（LR-），分析了STONE评分和CHOKAI评分在其最佳临界值时的预测性能。
96例符合纳入标准的患者中，79例被明确诊断为输尿管结石。所有患者均为日本血统。CHOKAI评分的AUC在最佳临界值为6时为0.971，敏感性为0.911，特异性为0.941，LR+为15.49，LR-为0.094。STONE评分的AUC在最佳临界值为8时为0.873，敏感性为0.823，特异性为0.824，LR+为4.662，LR-为0.215。CHOKAI评分的AUC显著高于STONE评分（p=0.010）。CHOKAI评分≥6的73例患者中，98.6%有输尿管结石，STONE评分≥8的68例患者中，95.6%有输尿管结石。
简化的CHOKAI评分是筛查肾绞痛患者输尿管结石的有用工具。
