Application of decision rules on diagnosis and prognosis of renal colic: a systematic review and meta-analysis

Abstract

Renal colic is a prevalent emergency department presentation resulting from urolithiasis. Clinical decision rules for the diagnosis of urolithiasis were developed to help clinicians with better judgment. In this systematic review, we assessed the performance of prediction rules on urolithiasis diagnosis and prognosis. MEDLINE, Embase, Web of Science, and Scopus were searched for studies on the performance of a clinical decision tool for diagnosis or prognosis of urolithiasis. Performance and accuracy of the rules were the key outcomes of interest. Databases were searched from inception to March 2019. Of the 4980 articles reviewed, 28 studies were included in the present analysis. Twenty-one studies were on urolithiasis diagnosis (including eight studies on STONE rule), and 10 studies reported urolithiasis outcomes. Studies were at low to moderate risk of bias. The pooling of data on STONE showed that the prevalence of urolithiasis in low, moderate, and high risk groups were: 12% (95% confidence interval 9%–15%), 53% (95% confidence interval 43%–62%), and 83% (95% confidence interval 75%–91%), respectively. In the high risk score group, prevalence of clinically important alternative diagnosis was 1% (95% confidence interval 0%–2%) and 11% (95% confidence interval 8%–13%) of patients needed intervention. STONE scoring system is useful in estimating the prevalence of urolithiasis but high heterogeneity among the studies makes it unsuitable for application. Other decision tools were poorly studied and cannot be recommended for clinical use.

The Use of Visual Analogue Scale Score as a Predicting Tool in Differentiating Renal Colic From Lumbar Back Pain

“…In 2018, Başeskioğlu et al designed the Osmangazi University Score, which used nausea, a history of stones, Cre, and hematuria [ 5 ]. In a meta-analysis that included the aforementioned scoring systems along with six others, Mirfazaelian et al found the STONE scoring system to be superior to others [ 1 , 19 - 22 ]. The same year, Fukuhara et al reported that the CHOKAAI score was superior to STONE [ 23 ].…”

“…Urolithiasis is a common disease with a lifetime incidence of 12% and a high cost for healthcare worldwide [ 1 , 2 ]. Although ultrasonography (US) is the first-line diagnostic method in stone diagnosis, it is highly dependent on the attention and experience of the person performing it, and its sensitivity remains low, especially in detecting ureteral and kidney stones [ 3 ].…”

“…Although ultrasonography (US) is the first-line diagnostic method in stone diagnosis, it is highly dependent on the attention and experience of the person performing it, and its sensitivity remains low, especially in detecting ureteral and kidney stones [ 3 ]. Therefore, non-contrast computed tomography (CT), a gold standard diagnostic method, is frequently used to reach a definitive diagnosis, but its use increases the cost and exposure to radiation [ 1 , 4 , 5 ].…”

What are the clinical effects of the different emergency department imaging options for suspected renal colic? A scoping review

“…Summary of current evidence A total of 21 publications addressed this question via different methods, including 8 retrospective studies, 7 prospective observational studies, 4 systematic reviews, and 2 RCTs (Table 2 in Supplement B). 2,6,12,15,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Only 1 study directly compared immediate CT to delayed CT in patients who were clinically improving in the EDand neither group had any alternative diagnoses considered lifethreatening. 28 "Alternative diagnoses" were not standardized and were not always clearly defined as dangerous, emergent, or urgent.…”

“…A total of 14 studies sought to develop and validate prediction rules with the goal of predicting the likelihood that a patient with flank pain has ureterolithiasis (Table 6 in Supplement B). 24,30,32,[48][49][50][51][52][53][54][55][56][57][58] Of the 14 studies included, 1 was a 2019 meta-analysis that sought to assess the performance of existing prediction rules. The STONE score and the CHOKAI score were most frequently evaluated.…”