The prevalence of urinary stones is steadily increasing due to changing dietary habits and living conditions, leading to a significant number of emergency department (ED) visits, primarily for severe pain. While managing pain is crucial, accurate diagnosis remains essential. Non-enhanced CT is the gold standard for detecting urinary stones because of its high sensitivity and specificity. However, repeated CT scans raise concerns due to radiation exposure, especially in cases of recurrent stones. To address this, clinical scoring systems like STONE, STONE PLUS, and CHOKAI have been developed to predict the presence of ureteral stones and reduce unnecessary imaging. This study compared the diagnostic accuracy of these three scoring systems in identifying large ureteral stones (≥5mm) in patients presenting with flank pain. The CHOKAI score demonstrated superior diagnostic performance compared to the STONE and STONE PLUS scores in detecting ureteral stones. However, CHOKAI and STONE PLUS were equally effective in identifying large stones. Unlike STONE, the CHOKAI and STONE PLUS scores incorporate ultrasound findings, particularly hydronephrosis, which significantly enhance their diagnostic value. Given that stones under 5mm often pass spontaneously, accurately identifying stone size is vital for guiding treatment. Incorporating stone size into prediction models can improve triage decisions, minimise radiation exposure, and reduce unnecessary interventions. However, scoring systems should be supported with structured follow-up strategies to avoid missed diagnoses. The study’s limitations include its retrospective, single-centre design and lack of laboratory data. No new scoring system was introduced, but existing ones were evaluated for their utility. In conclusion, CHOKAI and STONE PLUS scores are effective tools for detecting large ureteral stones, potentially improving patient care by aiding clinical decisions while limiting CT usage.
Comparison of CHOKAI, STONE and STONE PLUS scores
Reviewed by Asif H Ansari
Comparison of the diagnostic utility of CHOKAI, STONE and STONE PLUS scores in predicting ureteral stones larger than 5mm.
