Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone--the STONE score: retrospective and prospective observational cohort studies.
Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone--the STONE score: retrospective and prospective observational cohort studies.
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DOI：
10.1136/bmj.g2191
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发表时间：
2014-03-26
期刊：
影响因子：
--
通讯作者：
Gross CP
中科院分区：
文献类型：
--
作者：
Moore CL;Bomann S;Daniels B;Luty S;Molinaro A;Singh D;Gross CP
目的推导并验证一种适合CT检查的无并发症输尿管结石患者的客观临床预测规则。我们假设输尿管结石的可能性高的患者发生急性重要的其他结果的可能性低。设计回顾性观察推导队列;前瞻性观察验证队列。设置城市三级急诊科和郊区独立社区急诊科。受试者因疑似无并发症肾结石而接受非增强CT检查的成人。推导队列包括随机选择的2005年4月至2010年11月期间接受CT的患者（1040例患者）;验证队列包括2011年5月至2013年1月期间连续前瞻性入组的患者（491例患者）。在推导阶段，从对口述CT报告不知情的病历中推导出与症状性输尿管结石潜在相关的先验因素，并根据诊断单独分类。采用多变量逻辑回归分析确定与输尿管结石相关的前5个因素，并将这些因素分配为整数点，以创建一个评分系统，该系统分为输尿管结石的低、中、高概率。在前瞻性研究中，该评分是在对CT结果不知情的情况下通过观察得出的，并与输尿管结石的患病率和其他重要的症状原因进行比较。结果衍生样本包括1040条记录，发现5个因素最能预测输尿管结石：男性，疼痛持续时间短，非黑人种族，恶心或呕吐的存在，以及显微镜下血尿，得分为0-13（STONE评分）。对491名参与者进行了前瞻性验证。在推导和验证队列中，低概率（评分0-5）组中输尿管结石的发生率分别为8.3%和9.2%，中等概率（评分6-9）组中输尿管结石的发生率分别为51.6%和51.3%，高概率（评分10-13）组中输尿管结石的发生率分别为89.6%和88.6%。在高分组中，衍生队列中有0.3%和验证队列中有1.6%存在非常重要的替代结果。结论STONE评分可靠地预测了无并发症的输尿管结石的存在，并且出现严重重要替代结果的可能性较低。在未来的研究中纳入可能有助于限制暴露于辐射和过度使用成像。试用注册www.clinicaltrials.gov NCT 01352676。
Objective To derive and validate an objective clinical prediction rule for the presence of uncomplicated ureteral stones in patients eligible for computed tomography (CT). We hypothesized that patients with a high probability of ureteral stones would have a low probability of acutely important alternative findings. Design Retrospective observational derivation cohort; prospective observational validation cohort. Setting Urban tertiary care emergency department and suburban freestanding community emergency department. Participants Adults undergoing non-contrast CT for suspected uncomplicated kidney stone. The derivation cohort comprised a random selection of patients undergoing CT between April 2005 and November 2010 (1040 patients); the validation cohort included consecutive prospectively enrolled patients from May 2011 to January 2013 (491 patients). Main outcome measures In the derivation phase a priori factors potentially related to symptomatic ureteral stone were derived from the medical record blinded to the dictated CT report, which was separately categorized by diagnosis. Multivariate logistic regression was used to determine the top five factors associated with ureteral stone and these were assigned integer points to create a scoring system that was stratified into low, moderate, and high probability of ureteral stone. In the prospective phase this score was observationally derived blinded to CT results and compared with the prevalence of ureteral stone and important alternative causes of symptoms. Results The derivation sample included 1040 records, with five factors found to be most predictive of ureteral stone: male sex, short duration of pain, non-black race, presence of nausea or vomiting, and microscopic hematuria, yielding a score of 0-13 (the STONE score). Prospective validation was performed on 491 participants. In the derivation and validation cohorts ureteral stone was present in, respectively, 8.3% and 9.2% of the low probability (score 0-5) group, 51.6% and 51.3% of the moderate probability (score 6-9) group, and 89.6% and 88.6% of the high probability (score 10-13) group. In the high score group, acutely important alternative findings were present in 0.3% of the derivation cohort and 1.6% of the validation cohort. Conclusions The STONE score reliably predicts the presence of uncomplicated ureteral stone and lower likelihood of acutely important alternative findings. Incorporation in future investigations may help to limit exposure to radiation and over-utilization of imaging. Trial registration www.clinicaltrials.gov NCT01352676.
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6.2
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