Department of Emergency Medicine, Tehran University of Medical Sciences.
Department of Epidemiology, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Eur J Emerg Med. 2020 Apr;27(2):87-93. doi: 10.1097/MEJ.0000000000000610.
Renal colic is a prevalent emergency department presentation resulting from urolithiasis. Clinical decision rules for the diagnosis of urolithiasis were developed to help clinicians with better judgment. In this systematic review, we assessed the performance of prediction rules on urolithiasis diagnosis and prognosis. MEDLINE, Embase, Web of Science, and Scopus were searched for studies on the performance of a clinical decision tool for diagnosis or prognosis of urolithiasis. Performance and accuracy of the rules were the key outcomes of interest. Databases were searched from inception to March 2019. Of the 4980 articles reviewed, 28 studies were included in the present analysis. Twenty-one studies were on urolithiasis diagnosis (including eight studies on STONE rule), and 10 studies reported urolithiasis outcomes. Studies were at low to moderate risk of bias. The pooling of data on STONE showed that the prevalence of urolithiasis in low, moderate, and high risk groups were: 12% (95% confidence interval 9%-15%), 53% (95% confidence interval 43%-62%), and 83% (95% confidence interval 75%-91%), respectively. In the high risk score group, prevalence of clinically important alternative diagnosis was 1% (95% confidence interval 0%-2%) and 11% (95% confidence interval 8%-13%) of patients needed intervention. STONE scoring system is useful in estimating the prevalence of urolithiasis but high heterogeneity among the studies makes it unsuitable for application. Other decision tools were poorly studied and cannot be recommended for clinical use.
肾绞痛是一种常见的急诊科就诊病症，其主要病因为尿路结石。为了帮助临床医生更好地判断，人们制定了尿路结石的临床决策规则。在本系统综述中，我们评估了预测规则在尿路结石诊断和预后中的表现。我们检索了 MEDLINE、Embase、Web of Science 和 Scopus 中关于尿路结石诊断或预后的临床决策工具表现的研究。规则的性能和准确性是我们主要关注的关键结果。数据库的检索范围为建库至 2019 年 3 月。在审查的 4980 篇文章中，有 28 项研究纳入本分析。其中 21 项研究为尿路结石的诊断（包括 8 项关于 STONE 规则的研究），10 项研究报告了尿路结石的结局。研究的偏倚风险为低至中度。对 STONE 数据的汇总分析显示，低、中和高危组尿路结石的患病率分别为：12%（95%置信区间 9%-15%）、53%（95%置信区间 43%-62%）和 83%（95%置信区间 75%-91%）。在高危评分组中，临床上重要的替代诊断的患病率为 1%（95%置信区间 0%-2%），需要干预的患者比例为 11%（95%置信区间 8%-13%）。STONE 评分系统可用于估计尿路结石的患病率，但由于研究间存在高度异质性，因此不适合应用。其他决策工具的研究较少，不能推荐用于临床应用。
