Pd47-12 Predictors of Infection in Patients Presenting to the Emergency Department With Obstructing Ureteral Calculi

Abstract

INTRODUCTION AND OBJECTIVES:The ability to predict which emergency department patients are likely to have a ureteral stone is useful for efficiency and cost-effectiveness in evaluation, imaging, and patient care. We performed the initial external validation of the STONE Score, a clinical prediction rule for the presence of uncomplicated ureteral stones in emergency department patients which was developed at Yale University School of Medicine.METHODS: Five-hundred thirty eight (538) consecutive patients evaluated in an urban tertiary care emergency department for the possible diagnosis of ureteral stone were retrospectively reviewed. The STONE score uses 5 factors (gender, duration of pain, race, nausea/ vomiting, erythrocytes on urine dipstick) to categorize patients into LOW, MEDIUM, and HIGH probability of having a ureteral stone. The total stone risk score is 0-13, divided into 3 groups e 0-5 ¼ LOW risk, 6-9 ¼ MOD-ERATE risk, and 10-13 ¼ high risk. Table 1 shows the scoring system.RESULTS: Of the 538 patients evaluated for suspected ureteral stone, 257 (47.8%) had a ureteral stone. Mean patient age was 45.9 years (SD 16.3) and gender prevalence was 43.9% female:56.1% male. Distribution of STONE score risk was 24.1% LOW, 48.1% MODERATE, and 27.7% HIGH. Diagnosis of ureteral stone by STONE score risk was 14% for LOW risk group, 48.3% for MODERATE risk group, and 75.8% for HIGH risk group. This distribution is very similar to internal validation at Yale University School of Medicine, where values were as follows: 8.3-9.2% for LOW risk, 51.3-51.6% for MODERATE risk, and 88.6% for HIGH risk.CONCLUSIONS: This external validation demonstrates that the STONE score accurately predicts the presence of a ureteral stone in patients who present to the ED with suspect ureteral colic. Use of the STONE score in evaluation of these patients may allow clinicians to more efficiently evaluate and triage these patients in the future.

Risk factors for concomitant positive midstream urine culture in patients presenting with symptomatic ureterolithiasis

“…Results from our multivariable logistic regression analysis confirm the previous univariable findings for early detection of UTI [ 8 , 12 , 13 , 15 ]. Nitrite has shown to deliver a low sensitivity of 16.7% but high specificity of 99.5% to diagnose UTI [ 8 , 15 ].…”