Dataset Information

Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic.

ABSTRACT:

Objectives

To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management.

Subject/patients

A 2517 patient dataset was utilised from an international multi-centre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflammatory Markers In Patients Presenting with Acute Ureteric Colic) of patients presenting with acute ureteric colic across 71 secondary care hospitals in the United Kingdom, Ireland, Australia, and New Zealand. Inclusion criteria mandated a non-contrast CT-KUB.

Methods

SSP was defined as the 'absence of the need for intervention'. The model was developed using logistic regression and backwards selection (to achieve lowest AIC) in a subset from 2009-2015 (n=1728) and temporally validated on a subset from 2016-2017 (n=789).

Results

Of the 2517 patients, 1874 had SSP (74.5%). Mean age (±[SD]) was 47 (±14.7) years and 1892 were male (75.2%). At the end of the modelling process, gender: male (OR 0.8, 95%CI 0.64-1.01, p=0.07), neutrophil count (OR 1.03, 95%CI 1.00-1.06, p = 0.08), hydronephrosis (OR 0.79, 95%CI 0.59-1.05, p=0.1), hydroureter (OR 1.3, 95%CI 0.97-1.75, p =0.08), stone size >5-7mm (OR 0.2, 95%CI 0.16-0.25, p<0.0001), stone size >7mm (OR 0.11, 95%CI 0.08-0.15, p<0.001), middle ureter stone position (OR 0.59, 95%CI 0.43-0.81, p=0.001), upper ureter stone position (OR 0.31, 95%CI 0.25-0.39, p<0.001) ), medical expulsive therapy use (OR 1.36, 95%CI 1.1 - 1.67, p = 0.001), oral NSAID use (OR 1.3, 95%CI 0.99 - 1.71, p=0.06), and rectal NSAID use (OR1.17, 95%CI 0.9 - 1.53, p=0.24) remained. Concordance-statistic (C-statistic) was 0.77 (95%CI 0.75 - 0.80) and a nomogram was developed based on these.

Conclusion

The presented nomogram is available to use as an online calculator via www.BURSTurology.com and could allow clinicians and patients to make a more informed decision on pursuing conservative management versus early intervention.

SUBMITTER: Gao C

PROVIDER: S-EPMC9796920 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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Publications

Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic.

Gao Chuanyu C Peters Max M Kurver Piet P Anbarasan Thineskrishna T Jayaraajan Keerthanaa K Manning Todd T Cashman Sophia S Nambiar Arjun A Cumberbatch Marcus M Lamb Benjamin W BW Pickard Robert R Erotocritou Paul P Smith Daron D Kasivisvanathan Veeru V Shah Taimur T TT

BJU international 20220628

<h4>Objectives</h4>To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management.<h4>Subject/patients</h4>A 2517 patient dataset was utilised from an international multi-centre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflammatory Markers In Patients Presenting with Acute Ureteric Colic) of patients presenting with acute ureteric colic across 71 secondary care h ...[more]

PMID: 35762278

Similar Datasets

Project description:Purpose: To evaluate whether computer program-estimated urolith stone volume (SV) was a better predictor of spontaneous passage (SP) compared with program-estimated stone diameter (PD) or manually measured stone diameter (MD), and whether utilizing SV and MD together provided additional value in SP prediction compared with MD alone. Materials and Methods: Retrospective analysis of patients with acute renal colic and single renal/ureteral stone on CT from July 2017 to April 2020. Diameter obtained from radiology reports or manually measured when report not available. Semiautomated stone analysis software (qSAS) was used to estimate SV and PD. ROC analysis was performed to compare accuracy of SV vs MD vs PD in predicting SP by 2, 4, and 6 weeks. Subgroup analysis was performed by stone size (</≥6 mm) and location (proximal/distal). Results: Among 172 patients analyzed, SP occurred in 71 (41%). Patient age (mean 53), gender (38%F), and stone history/side did not differ significantly by SP. Average MD, PD, and SV were significantly smaller among SP stones vs stones requiring surgery (MD 4.3 mm vs 8.0 mm, PD 5.5 mm vs 9.4 mm, and SV 40 mm3 vs 312 mm3; p < 0.001). ROC analysis showed significantly higher area under curve (AUC) for SV for predicting SP by 4 and 6 weeks compared with MD and PD (AUC 0.93 vs 0.86 vs 0.85 4 weeks, p < 0.001; 0.92 vs 0.85 vs 0.86 6 weeks, p < 0.003). AUC difference between SV vs MD was much greater among stones ≥6 mm or proximal stones. Utilizing SV and MD together yielded improved positive predictive value and negative predictive value for SP prediction. Conclusions: SV is a more accurate predictor of SP compared with linear stone dimensions, especially in the setting of larger and/or more proximal stones. Utilizing SV and diameter together yielded improved SP predictions compared with using either metric alone. Prospective studies are indicated to investigate the clinical utility of SV for SP prediction.

Project description:BackgroundSporadic lymphangioleiomyomatosis (S-LAM) is a rare low-grade neoplasm of young women characterized by multiple pulmonary cysts leading to progressive dyspnea and recurrent spontaneous pneumothorax (SP). The diagnosis of S-LAM may be delayed by several years. To reduce this delay, chest computed tomography (CT) screening has been proposed to uncover cystic lung disease in women presenting with SP. However, the probability to discover S-LAM in this population has not been determined precisely. The aim of this study was to calculate the probability of finding S-LAM in women presenting with (a) SP, and (b) apparent primary SP (PSP) as first manifestation of S-LAM.MethodsCalculations were made by applying the Bayes theorem to published epidemiological data on S-LAM, SP and PSP. Each term of the Bayes equation was determined by meta-analysis, and included: (1) the prevalence of S-LAM in the general female population, (2) the incidence rate of SP and PSP in the general female population, and (3) the incidence rate of SP and apparent PSP in women with S-LAM.ResultsThe prevalence of S-LAM in the general female population was 3.03 per million (95% confidence interval 2.48, 3.62). The incidence rate of SP in the general female population was 9.54 (8.15, 11.17) per 100,000 person-years (p-y). The incidence rate of SP in women with S-LAM was 0.13 (0.08, 0.20). By combining these data in the Bayes theorem, the probability of finding S-LAM in women presenting with SP was 0.0036 (0.0025, 0.0051). For PSP, the incidence rate in the general female population was 2.70 (1.95, 3.74) per 100,000 p-y. The incidence rate of apparent PSP in women with S-LAM was 0.041 (0.030, 0.055). With the Bayes theorem, the probability of finding S-LAM in women presenting with apparent PSP as first disease manifestation was 0.0030 (0.0020, 0.0046). The number of CT scans to perform in women to find one case of S-LAM was 279 for SP and 331 for PSP.ConclusionThe probability of discovering S-LAM at chest CT in women presenting with apparent PSP as first disease manifestation was low (0.3%). Recommending chest CT screening in this population should be reconsidered.

Dataset Information

Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic.

Objectives

Subject/patients

Methods

Results

Conclusion

Publications

Nomogram predicting the probability of spontaneous stone passage in patients presenting with acute ureteric colic.

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