2014年的研究，
急診的情境中，因疑似無併發症腎結石預計要進行無顯影劑電腦斷層的成人為對象，
作者第一階段利用回溯性收案找出5個因素組成STONE score，
Sex: male or female
Timing: > 24h, 6-24h, < 6h
Origin: black or nonblack
Nausea: none, nausea alone, vomiting alone
Erythrocytes: hematuria absent or present
用來將尿路結石分類為低度可能性(0-5分)、中等可能性(6-9分)、高度可能性(10-13分)。
第二階段進行前膽性的收案，將上述對象進行STONE score評分及分類的驗証，
看這個用來預測結石可能性的評分系統好不好用。
另一個重要的訊息是，在最高分數的這一群中，
因急性且重大的其他原因造成症狀的的約0.3%-1.6%
這個臨床預測計分系統的應用在於:
如果病人的計分為高度可能，
代表結石的機會近9成，而因其他重大原因造成的機會約1%左右，
那這一類病人應該就可以免去CT的掃描。
要注意這個臨床計分對亞洲族群而言不適用的一部份是Race: black vs non-block
因此雖然有趣，看來簡單實用，但要根據這一個評份來改變臨床的行為還要更多証據來佐証。
用來將尿路結石分類為低度可能性(0-5分)、中等可能性(6-9分)、高度可能性(10-13分)
在高度可能的這一群中，
Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone—the STONE score: retrospective and prospective observational cohort studies
- Christopher L Moore, associate professor1,
- Scott Bomann, emergency physician1,
- Brock Daniels, emergency physician2,
- Seth Luty, research assistant3,
- Annette Molinaro, associate professor1,
- Dinesh Singh, assistant professor4,
- Cary P Gross, professor56
BMJ 2014;348:g2191
Abstract
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.
作者說給你聽: master.m3u8
