Presentation Authors: Hiroki Fukuhara*, Yamagata, Japan, Satoshi Takai, Sakata, Japan, Masato Kikuta, Kawanisi, Japan, Atsushi Yamagishi, Shinta Suenaga, Toshihiko Sakurai, Sei Naito, Hayato Nishida, Takuya Yamanobe, Tomoyuki Kato, Norihiko Tsuchiya, Yamagata, Japan
Introduction: CHOKAI and STONE are clinical scoring systems for predicting the presence ureteral stones. The former system consists of seven categories : sex, timing, age, nausea/vomiting symptoms, hematuria,erythrocytes, history of kidney stones, and hydronephrosis. The latter system consists of five categories: sex, timing, raceorigin , nausea/vomiting symptoms, and hematuriaerythrocytes. Both scoring systems have a possible high score of 13 points and define 6 or more points as indicating a high likelihood of ureteral stones. The aim of this study is to validate and compare the diagnostic performance of each scoring system.
Methods: This study was multicenter prospective observational study performed at five tertiary hospitals in Japan from 2017 to 2018. We looked at patients more than 15 years old who visited our hospital with renal colic suspected of being caused by a ureteral stone. We calculated the CHOKAI and STONE scores of each patient based on the physical and laboratory findings. The primary outcome was the area under the curve (AUC) differences with receiver operating characteristic curve in each model. The secondary outcome was to determine an optimal cut-off score and the diagnostic accuracy of each model in Japan.
Results: Of the 124 patients included in this study, 84 were diagnosed with ureteral stones. The AUC of the CHOKAI scores was 0.956 (95% confidence interval [CI], 0.920 - 0.992) at an optimal cut-off point of 6, and it showed a sensitivity of 0.929 (95% CI, 0.851 - 0.973), specificity of 0.900 (95% CI, 0.763 - 0.972), positive likelihood ratio (LR+) of 9.286 (95% CI, 3.658 - 23.57), and negative likelihood ratio (LR-) of 0.079 (0.036 - 0.173). The AUC of the STONE scores was 0.883 (95% CI, 0.826 - 0.940) at an optimal cut-off point of 9, and it showed a sensitivity of 0.679 (95% CI, 0.568 - 0.776), specificity of 0.900 (95% CI, 0.763 - 0.972), LR+ of 6.786 (95% CI, 2.647 - 17.39), and LR- of 0.357 (95% CI, 0.257 - 0.496). The AUC of the CHOKAI score was significantly higher than that of the STONE score (p=0.0032).
Conclusions: The CHOKAI score has diagnostic performance superior to that of the STONE score in this population.