Internal validation of a scoring system to evaluate the probability of ureteral stones: The CHOKAI score

Fukuhara, Hiroki; Ichiyanagi, Osamu; Midorikawa, Shinichi; Kakizaki, Hiroshi; Kaneko, Hisashi; Tsuchiya, Norihiko

doi:10.1016/j.ajem.2017.06.023

Cited by 23 publications

(18 citation statements)

References 22 publications

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“…After removal of duplicate studies, our search initially retrieved 7641 studies of which 250 were assessed as full‐text documents (Figure 1 ). Of these, 76 studies 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , …”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

et al. 2022

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Study Objective The objective of this study was to conduct a systematic review and meta‐analysis of the diagnostic accuracy of the clinical signs, symptoms, laboratory investigations, and imaging modalities commonly used in patients with clinically suspected renal colic. Methods We conducted this systematic review and meta‐analysis according to an a priori, registered protocol (PROSPERO CRD42017055153). A literature search was performed using MEDLINE and EMBASE from inception to July 2, 2020. We assessed the risk of bias using Quality Assessment of Diagnostic Accuracy Studies–2, calculated likelihood ratios (LRs), and applied a random‐effects model for meta‐analysis. Results Among 7641 references screened, 76 were included in the systematic review and 53 were included in the meta‐analyis. The overall pooled prevalence for ureteral stones was 63% (95% confidence interval [CI], 58%–67%). No individual demographic feature, symptom, or sign when present had an LR+ ≥2.0 for identifying ureterolithiasis. A (Sex, Timing and Origin of pain, race, presence or absence of Nausea, and Erythrocytes) STONE score ≥10 increased (sensitivity 0.49, specificity 0.91, LR 5.3 [95% CI, 4.1–6.7]) and a STONE score <6 reduced the likelihood of ureteral stones (sensitivity 0.94, specificity 0.43, LR 0.15 [95% CI, 0.10–0.22]). Standard‐dose (sensitivity 0.96, specificity 0.94, LR+ 16 [95% CI, 11–23], LR− 0.05 [95% CI, 0.03–0.07]) and low‐dose computed tomography (CT) scanning (sensitivity 0.93, specificity 0.94, LR+ 17 [95% CI, 8.8–31], LR− 0.08 [95% CI, 0.03–0.19]) were the most useful imaging techniques for identifying patients with or without ureteral stones. Conclusions Individual signs, symptoms, or the presence of microscopic hematuria do not substantially impact the likelihood of ureteral stones in patients with clinically suspected renal colic. The STONE score at high and low thresholds and a modified STONE score at a high threshold may sufficiently guide physicians’ decisions to obtain imaging. Low‐dose, non‐contrast CT imaging provides superior diagnostic accuracy compared with all other imaging index tests that are comparable with standard CT imaging. Limitations of the evidence include methodological shortcomings and considerable heterogeneity of the included studies.

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Section: Resultsmentioning

confidence: 99%

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

et al. 2022

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“…If the patients are suitable for the criteria, renal colic can be considered via fast track and patients could be provided with rapid analgesia and their consult with the urologist could be accelerated. In 2017, Fukuhara et al developed CHOKAAI (distension of kidney Capsule, Hydronephrosis, Occult blood in urine, Kidney stone history, Adult, Age, Diminution of pain within six hours) scoring system [ 10 ]. In 2018, Başeskioğlu et al designed the Osmangazi University Score, which used nausea, a history of stones, Cre, and hematuria [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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

Caniklioğlu¹,

Özkaya²

2021

Cureus

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Introduction Renal colic is often confused with low back pain (LBP) and other pathologies. Computed tomography (CT) is frequently used to reach a definitive diagnosis, but its use increases the exposure to radiation. Researchers have tried to predict urinary stones in patients presenting with flank pain. Several scoring systems have been introduced; however, none of them provide a prediction based on the physical examination of the patient upon initial presentation to the outpatient clinic. In this study, we aimed to investigate whether we can predict the presence of stone with visual analogue scale (VAS) questionnaire during the first admission. Materials and methods Patients with complaints of flank pain were started to be followed for three months in our urology clinic. After the definitive diagnosis was made the patients were classified into two groups: renal colic group (group 1; n=36) and the LBP group (group 2; n=30). Results In logistic regression analysis, the possibility of renal colic increased 5.4 times more per one-unit increase in the VAS score. In receiver operating characteristic (ROC) analyses, when the VAS was 4.5, the diagnosis of renal colic could be made with 88% sensitivity and 71% specificity. Conclusion If the VAS score is ≤ 4 in patients that have flank pain without limitation of movement, it is more likely to manage these patients with a simple medical treatment plan. In these patients, unnecessary ultrasonography (US) scans be reduced by 86.3% and unnecessary CT scans by 88.8%. A VAS score of ≥5 should warn the clinician about the necessity of routine urinary stone examinations.

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“…14 Then, US was included in the CHOKAI scoring system, which emerged as a more sensitive system than STONE. 13 The main difference between these two scoring systems is that STONE PLUS uses point-of-care US, while CHOKAI uses routine US. In our study, routine US findings were used to compare our results with CHOKAI.…”

Section: Discussionmentioning

confidence: 99%

External validation of STONE, modified STONE, and CHOKAI scores for the diagnosis of ureteral stones in the Turkish population

Acar

Uysal

2020

Hong Kong Journal of Emergency Medicine

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Background: Scoring systems seem to be effective in the management of patients with uncomplicated ureteral stones. However, their efficiency may differ by population. Objectives: We aimed to validate STONE, modified STONE, and CHOKAI scores for the diagnosis of ureteral stones in the Turkish population. Methods: We conducted a retrospective chart review between 01 February 2018 and 30 November 2018, in an academic emergency department. Demographics, laboratory findings, and radiologic tests of patients with flank pain were obtained. Computed tomography was used as the gold standard for the diagnosis of ureteral stones. STONE, modified STONE, and CHOKAI scores were calculated for each patient. The performance of the scoring systems was compared in terms of their specificity, sensitivity, positive likelihood ratio, negative likelihood ratio, negative predictive value, and positive predictive value. Results: A total of 157 patients were included in the study. The mean age was 38.47 ± 14.87 years, and 103 (65.6%) of the patients were males. The prevalence of ureteral stones was 84.0%, 88.9%, and 85.0% in the high-risk patients and 12%, 9.4%, and 22.7% in the low-risk patients for the STONE, modified STONE, and CHOKAI scores, respectively. Area under the curve values for the STONE, modified STONE, and CHOKAI scores were 0.776 (p = 0.001; 0.692–0.860 95% confidence interval), 0.825 (p < 0.001; 0.749–0.901 95% confidence interval), and 0.869 (p < 0.001; 0.806–0.932 95% confidence interval), respectively. The specificity and sensitivity values of STONE, modified STONE, and CHOKAI scores for the diagnosis of ureteral stones were 64.71, 71.70; 70.59, 87.74; and 66.67, 90.57, respectively. Conclusion: The CHOKAI score displayed the best performance compared to STONE and modified STONE in diagnosing ureteral stones in the Turkish population.

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Internal validation of a scoring system to evaluate the probability of ureteral stones: The CHOKAI score

Abstract: The simplified CHOKAI score is a useful tool to screen for ureteral stones in patients with renal colic.

Cited by 23 publications

References 22 publications

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

A systematic review and meta‐analysis of clinical signs, symptoms, and imaging findings in patients with suspected renal colic

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

External validation of STONE, modified STONE, and CHOKAI scores for the diagnosis of ureteral stones in the Turkish population

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