Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Endourol. 2021 Jun;35(6):847-852. doi: 10.1089/end.2020.0978. Epub 2020 Nov 16.
Kidney stone recurrence rates vary between patients. A patient's risk informs the frequency and intensity of preventative interventions. Clinicians routinely use clinical experience to estimate risk. We sought to compare clinician estimated recurrence risk with the recurrence of kidney stones (ROKS) nomogram. We surveyed members of the Endourological Society with clinical expertise in kidney stones. Respondents estimated the risk of recurrence for patients in three clinical vignettes corresponding to low, intermediate, and high recurrence risk from the nomogram. Clinician estimates were compared with ROKS estimates. The majority of the 318 respondents were from North America ( = 127, 40%). The most commonly estimated recurrence was 50% at 5 years. The respondents' estimates were significantly different from the ROKS predicted recurrence rate for all cases (Case 1, 50% 93% < 0.0001; Case 2, 50% 60% < 0.0001; Case 3, 60% 22% < 0.0001). The ROKS predicted estimates ranged from 22% to 93%, whereas the median urologist-derived 5-year risk estimates for each case ranged from 50% to 60%. The median range of estimates by respondents across cases was 20%, narrower than the 71% for the ROKS nomogram. The majority of respondents (95%) do not use nomograms in practice, mostly because of lack of awareness of useful nomograms (59%). This study suggests that clinicians may not be able to distinguish those with high and low recurrence risk when compared with peers and when compared with a nomogram. Clinical decision support tools are needed to enable clinicians to better estimate stone recurrence risk.
肾结石复发率在患者之间存在差异。患者的风险决定了预防干预的频率和强度。临床医生通常会根据临床经验来估计风险。我们旨在比较临床医生估计的复发风险与肾结石复发风险（ROKS）列线图。我们调查了具有肾结石临床专业知识的内镜学会会员。受访者根据列线图中的低、中、高复发风险，分别对应三个临床病例，估计这些患者的复发风险。将临床医生的估计与 ROKS 估计进行比较。在 318 名受访者中，大多数来自北美（ = 127，40%）。最常估计的复发率为 5 年内 50%。对于所有病例，受访者的估计与 ROKS 预测的复发率明显不同（病例 1，50% 93% < 0.0001；病例 2，50% 60% < 0.0001；病例 3，60% 22% < 0.0001）。ROKS 预测的估计范围从 22%到 93%，而中位数泌尿科医生对每个病例的 5 年风险估计范围从 50%到 60%。受访者对各病例的中位数估计范围为 20%，比 ROKS 列线图的 71%更窄。大多数受访者（95%）在实践中不使用列线图，主要是因为缺乏对有用列线图的认识（59%）。本研究表明，与同行相比，与列线图相比，临床医生可能无法区分高复发风险和低复发风险的患者。需要临床决策支持工具，使临床医生能够更好地估计结石复发风险。
