What is the STONE score and how is used in the diagnosis of nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Moore and colleagues derived and validated an objective clinical prediction rule for uncomplicated ureteral stones that uses five patient factors—sex, timing, origin (ie, race), nausea, and erythrocytes (STONE)—to create a score between 0 and 13 (the STONE score). Patients with a high STONE score are very likely to have a kidney stone and very unlikely to have an important disorder other than a kidney stone as a cause of their symptoms, and thus may be able to avoid a computed tomography (CT) scan or be evaluated with a reduced-dose scan. [19]

The following factors were most predictive of ureteral stones:

  • Male sex
  • Short duration of pain
  • Non-black race
  • Presence of nausea or vomiting
  • Microscopic hematuria

In the validation cohort, probability by STONE score and percentage of patients found to have ureteral stones were as follows [19] :

  • Low probability (STONE score 0-5): 9.2% of patients
  • Moderate probability (score 6-9): 51.3% of patients
  • High probability (score 10-13): 88.6% of patients

CT scans revealed acutely important alternative causes of symptoms on CT scan in 2.9% and 3.7% of the derivation and validation cohorts overall. In the high score group, however, only 0.3% of the derivation cohort and 1.6% of the validation cohort had acutely important alternative findings. [19]


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