External Validation of a Preoperative Renal Stone Grading System: Reproducibility and Inter-rater Concordance of the Guy's Stone Score Using Preoperative Computed Tomography and Rigorous Postoperative Stone-free Criteria

Ingimarsson, Johann P.; Dagrosa, Lawrence; Hyams, Elias S.; Pais, Vernon M.

doi:10.1016/j.urology.2013.09.008

Cited by 70 publications

(49 citation statements)

References 9 publications

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“…This ensures the wider external validity of study findings, while data exists that the method of radiological assessment of clearance does not invalidate the prognostic utility of the scoring systems [6,16,18].…”

Section: Discussionmentioning

confidence: 94%

“…However, this does not invalidate 'comparative' conclusions from the study, as validation of ordinal scores for more strict SFR criteria has been done previously [8,16]. Similarly, we have not chosen CT to assess stone clearance; however, data exists that radiological assessment of clearance does not invalidate the prognostic utility of the scoring systems [6,16,18]. We have analysed only two observers for inter-rater and test-retest validation;…”

Section: Limitationsmentioning

confidence: 99%

“…and CROES scores also found to be associated with complications), although cross-comparative studies have been fewer [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The only systematic review concluded with ambiguity over the clear superiority of any one system and recommended further validation studies [23].…”

Section: Introductionmentioning

confidence: 99%

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Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

2016

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Objectives To assess the reliability of the Guy's Stone Score, the Seoul National University Renal Stone Complexity (S‐ReSC) score and the S.T.O.N.E. scores in percutaneous nephrolithotomy (PCNL), and assess their utility in discriminating outcomes [stone free rate (SFR), complications, need for multiple PCNL sessions, and auxiliary procedures] valid across parameters of experience of surgeon, independence from surgical approach, and variations in institution‐specific instrumentation. Patients and methods A prospectively maintained database of two tertiary institutions was analysed (606 cases). Institutes differed in instrumentation, while the overall surgical team comprised: two trainees (experience <100 cases), two junior consultants (experience 100–200 cases), and two senior surgeons (experience >1000 cases). Scores were assigned and re‐assigned after 4 months by one trainee and an expert surgeon. Inter‐rater and test‐retest agreement were analysed by Cohen's κ and intraclass correlation coefficient. Multivariate logistic regression models were created adjusting outcomes for the institution, comorbidity, Amplatz size, access tract location, the number of punctures, the experience level of the surgeon, and individual scoring system, and receiver operating curves were analysed for comparison. Results Despite some areas of inconsistencies, individually all scores had excellent inter‐rater and test‐retest concordance. On multivariable analyses, while the experience of the surgeon and surgical approach characteristics (such as access tract location, Amplatz size, and number of punctures) remained independently associated with different outcomes in varying combinations, calculus complexity scores were found consistently to be independently associated with all outcomes. The S‐ReSC score had a superior association with SFR, the need for multiple PCNL sessions, and auxiliary procedures. Conclusion Individually all scoring systems performed well. On cross comparison, the S‐ReSC score consistently emerged to be more superiorly associated with all outcomes, signifying the importance of the distributional complexity of the calculus (which also indirectly amalgamates the influence of stone number, size, and anatomical location) in discriminating outcomes. Our study proves the utility of scoring systems in prognosticating multiple outcomes and also clarifies important aspects of their practical application including future roles such as benchmarking, audit, training, and objective assessment of surgical technique modifications.

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Section: Discussionmentioning

confidence: 94%

Section: Limitationsmentioning

confidence: 99%

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Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

2016

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“…This score categorizes patients according to the complexity of the stone and the pelvicaliceal anatomy based on plain radiography, ultrasonography, computed tomogra-phy (CT) and intravenous urography findings [6] , as validated by a recent study. [7] There are four different categories for GSS in relation to the proposed SFR as category 1 (81%), 2 (72.4%), 3 (35%), and 4 (29%). [6] In March 2013 the S.T.O.N.E nephrolithometric score was reported, based on 5 characteristics detected on preoperative non contrast-enhanced CT.…”

Section: Introductionmentioning

confidence: 99%

Rearrangement of the Guy’s stone score improves prediction of stone-free rate after percutaneous nephrolithotomy

Moreno‐Palacios

García-Peña

et al. 2018

Turkish Journal of Urology

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Objective: We propose a modification of the original Guy´s Stone Score (GSS) to hold on 20 % of prognostic discrimination among groups which makes this score a more reliable resource for risk assessment in patients undergoing percutaneous nephrolithotomy (PCNL). Material and methods:Historical cohort of 126 patients undergoing PCNL from December 2010 to November 2014 was included in the survey. Every patient was classified according to the original GSS. For the new classification of Guy Stone Score (GSS-M) all of the subgroups included in the scale were analyzed individually and then ranked from better to worst according to the postoperative stone-free rates (SFRs). This ranking led us to reclassify all the original subgroups, clustering them in three new categories according to their SFRs as subgroups of good, intermediate and poor prognosis, trying to achieve at least 20% of prognostic discrimination among the groups.Results: Hundred and twenty-six PCNL procedures were evaluated, but only 124 were included for statistical analysis and classified based on SFR according to the GSS as follows: 76% for grade 1, 71% for grade 2, 55% for grade 3 and 20% for grade 4. The SFRs were also assessed for the GSS-M obtaining the following predictive values as 93%, 67% and 44% for the good, intermediate and poor prognostic groups, respectively. The prognostic difference among the GSS-M groups was always >20% (p<0.05). Conclusion:The original GSS has limitations to predict SFR because of its poor discrimination power among prognostic groups. This rearrangement improves prediction of SFR and better discriminates risk groups in PCNL.

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“…nephrolithometry [8] and CROES nomogram [9]. All of them haves proven to be significant in predicting stone-free rates after PCNL [10][11][12]. However, their use as a predictive tool for intraoperative fluoroscopy use has never been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Parameters Affecting Fluoroscopy Time During Percutaneous Nephrolithotomy: Focus on the Predictive Role of Guy's, S.T.O.N.E., and CROES Scoring Systems

SfoungaristosStavros

GofritOfer

YutkinVladimir

et al. 2015

Journal of Endourology

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External Validation of a Preoperative Renal Stone Grading System: Reproducibility and Inter-rater Concordance of the Guy's Stone Score Using Preoperative Computed Tomography and Rigorous Postoperative Stone-free Criteria

Cited by 70 publications

References 9 publications

Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

Comparative testing of reliability and audit utility of ordinal objective calculus complexity scores. Can we make an informed choice yet?

Rearrangement of the Guy’s stone score improves prediction of stone-free rate after percutaneous nephrolithotomy

Evaluating Parameters Affecting Fluoroscopy Time During Percutaneous Nephrolithotomy: Focus on the Predictive Role of Guy's, S.T.O.N.E., and CROES Scoring Systems

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