Malik Abdul, Mohkumuddin Syed, Yousaf Shazia, Baig Mirza Ahmad Raza, Afzal Ayesha
Dr. Abdul Malik FCPS Medicine, FCPS (Fellow Nephrology), Senior Registrar Internal Medicine, Sandeman Provincial Hospital, Quetta, Pakistan.
Dr. Syed Mohkumuddin (FCPS Nephrology), Assistant Professor Nephrology, Sandeman Provincial Hospital, Quetta, Pakistan.
Pak J Med Sci. 2020 Nov-Dec;36(7):1693-1697. doi: 10.12669/pjms.36.7.2625.
To determine the external validity of STONE score for predicting the probability of ureteral stone in patients presenting in emergency department with suspicion of ureteral stones.
In this prospective validation study, a total of 134 patients aged above 18 years, and first time arrived in the emergency unit for treatment of flank pain and then referred for the CT scan for suspected ureteral stone in Sandeman Provincial Hospital, Quetta, from 10-June-2018 to 15-Oct-2019 were included. STONE score calculation was done before sending the patient to the CT scan, using the same protocol as defined by Moore et al. Based on STONE score patients classified into the low-risk group (0 to 5), moderate-risk group (5 to 9) and the high-risk group (10 to13). The AUC, sensitivity, specificity and test characteristics were calculated for STONE score.
The mean age was 39.2± 11.2 years, there were 86 (64.17%) men and 48 (35.83%) women. there were 26.8% patients having low-risk score, 52.23% moderate-risk and 21.97% high-risk score. On receiver operating curve (ROC) the area under curve (AUC) of the stone score was 0.75 (95% CI, 0.67 to 0.83), the lower band of AUC 0.67 and upper band 0.83. In high risk STONE score the sensitivity of STONE score was 66.7% and specificity was 75.0%.
Based on our study results, CT scan and ultrasonography are standard diagnostic tools for suspected ureterolithiasis but in emergency unit, use of STONE score to categorize the patient as low risk, moderate-risk and high-risk of ureteral stone can help the physician (clinician) to take decision either there is a need of further investigation or not.
确定STONE评分在预测急诊科疑似输尿管结石患者输尿管结石发生概率方面的外部有效性。
在这项前瞻性验证研究中，纳入了2018年6月10日至2019年10月15日期间在奎达桑德曼省医院首次因胁腹疼痛到急诊科就诊、随后因疑似输尿管结石接受CT扫描的134例18岁以上患者。在将患者送去做CT扫描之前，按照Moore等人定义的相同方案计算STONE评分。根据STONE评分，将患者分为低风险组（0至5分）、中度风险组（5至9分）和高风险组（10至13分）。计算STONE评分的曲线下面积（AUC）、敏感性、特异性和检验特征。
平均年龄为39.2±11.2岁，男性86例（64.17%），女性48例（35.83%）。26.8%的患者为低风险评分，52.23%为中度风险，21.97%为高风险评分。在受试者工作特征曲线（ROC）上，结石评分的曲线下面积（AUC）为0.75（95%置信区间为0.67至0.83），AUC下限为0.67，上限为0.83。在高风险STONE评分中，STONE评分的敏感性为66.7%，特异性为75.0%。
根据我们的研究结果，CT扫描和超声检查是疑似输尿管结石的标准诊断工具，但在急诊科，使用STONE评分将患者分类为输尿管结石的低风险、中度风险和高风险，可帮助医生（临床医生）决定是否需要进一步检查。
