Journal of pharmacy & bioallied sciences · 2025
Validation of Modified STONE Score in Patients Presenting to Emergency Department with Flank Pain in a Tertiary Care Centre in South Kerala.
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John Sachin Joseph, Abraham Lissa, Tharian Susan
Аннотация
BACKGROUND: Ureteric calculi are a prevalent cause of acute flank pain in emergency departments (EDs). While non-contrast computed tomography (CT) is the diagnostic gold standard, its associated radiation exposure necessitates the development of accurate clinical prediction tools to stratify patients and optimize imaging utilization.
METHODS: This prospective, observational, cross-sectional study was conducted over 12 months. We enrolled 344 adult patients presenting with unilateral or bilateral flank pain. The modified STONE score (MSS), comprising five variables (male sex, pain duration <6 h, hematuria, prior stone history, and C-reactive protein <0.5 mg/dL), was calculated for each patient. All patients subsequently underwent a non-contrast CT scan, which served as the reference standard. Diagnostic performance was evaluated using Receiver Operating Characteristic curve analysis, determining the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
RESULTS: The mean age of participants was 47 ± 16 years, and 62% were male. Ureteric stones were confirmed by CT in 292 patients (84.9%). The MSS demonstrated excellent discriminative ability with an AUC of 0.956 (95% CI: 0.928-0.984). At an optimal cut-off score of ≥8, the sensitivity was 90.2% and specificity was 85.4% (PPV: 98.5%, NPV: 66.7%). At a cut-off of ≥7, specificity increased to 97.4% (PPV: 97.8%), though sensitivity decreased to 68.3%. The proportion of patients with ureteric stones increased significantly across low (25%), medium (66%), and high (99.6%) risk categories (P < 0.001).
CONCLUSION: The MSS is a highly accurate and reliable clinical tool for predicting ureteric calculi in the ED setting. Its use can effectively stratify patients into risk categories, potentially reducing unnecessary CT scans while ensuring timely diagnosis for high-risk individuals.
METHODS: This prospective, observational, cross-sectional study was conducted over 12 months. We enrolled 344 adult patients presenting with unilateral or bilateral flank pain. The modified STONE score (MSS), comprising five variables (male sex, pain duration <6 h, hematuria, prior stone history, and C-reactive protein <0.5 mg/dL), was calculated for each patient. All patients subsequently underwent a non-contrast CT scan, which served as the reference standard. Diagnostic performance was evaluated using Receiver Operating Characteristic curve analysis, determining the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
RESULTS: The mean age of participants was 47 ± 16 years, and 62% were male. Ureteric stones were confirmed by CT in 292 patients (84.9%). The MSS demonstrated excellent discriminative ability with an AUC of 0.956 (95% CI: 0.928-0.984). At an optimal cut-off score of ≥8, the sensitivity was 90.2% and specificity was 85.4% (PPV: 98.5%, NPV: 66.7%). At a cut-off of ≥7, specificity increased to 97.4% (PPV: 97.8%), though sensitivity decreased to 68.3%. The proportion of patients with ureteric stones increased significantly across low (25%), medium (66%), and high (99.6%) risk categories (P < 0.001).
CONCLUSION: The MSS is a highly accurate and reliable clinical tool for predicting ureteric calculi in the ED setting. Its use can effectively stratify patients into risk categories, potentially reducing unnecessary CT scans while ensuring timely diagnosis for high-risk individuals.