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J Korean Soc Emerg Med > Volume 30(6); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(6): 512-520.
일개 병원에서 STONE score와 modified STONE score의 외적 타당성 평가
이동욱1 , 서범석1 , 조영순2, 임훈2, 조준호3, 이선화4
1을지대학교 을지병원 응급의학과
2순천향대학교 부천병원 응급의학과
3연세대학교 의과대학 응급의학교실
4인제대학교 상계백병원 응급의학과
External validation of STONE score and modified STONE score
Dong Wuk Lee1 , Beom Sok Seo1 , Young Soon Cho2, Hoon Lim2, Jun Ho Cho3, Sunhwa Lee4
1Department of Emergency Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
2Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
3Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
4Department of Emergency Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
Correspondence  Beom Sok Seo ,Tel: 02-970-8282, Fax: 02-970-8865, Email: buddy57@hanmail.net,
Received: May 21, 2019; Revised: July 18, 2019   Accepted: September 9, 2019.  Published online: December 31, 2019.
ABSTRACT
Objective:
The STONE score and modified STONE score are useful clinical prediction rules for ureteral calculi. This study performed an external validation of the STONE score and modified STONE score. The purpose of this study was to minimize the economic cost and radiation exposure of computed tomography.
Method:
The electronic medical records of patients complaining of flank pain from January 2016 to December 2017 at a single emergency department were reviewed retrospectively. The patients were classified into three groups according to the STONE score and modified STONE score. The prevalence of urethral calculi and other important alternative diagnoses were calculated in each group.
Results:
Out of 561 patients, 266 patients were enrolled in this study, and 222 patients (83.5%) had a ureteral calculus. The same 266 patients were compared using the two clinical decision rule, STONE score, and the modified STONE score. The patients were classified into three groups. The prevalence of ureteral stones in the STONE score was 18.8% in the low-score group, 81.7% in the moderate-score group, and 91.1% in the high-score group. The prevalence of the modified STONE score was 20.0% in the low-score group, 54.1% in the moderate-score group, and 93.0% in the highscore group. The area under the curve of the modified STONE score was 0.779 higher than the area under the STONE score curve 0.73.
Conclusion:
The modified STONE score has superior diagnostic specificity to the STONE score.
Key words: Ureteral calculi; X-ray computed tomography; Clinical decision support systems
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