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Derivation of a clinical predicting rule for obstructive urolithiasis and alternative diagnosis requiring urgent intervention: the CLAD score

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Abstract

Most patients with renal colic are discharged from the emergency department (ED) after evaluation and pain alleviation. These patients may not require urgent imaging by computed tomography. We derived a clinical prediction score in patients with renal colic to identify those at very low risk for complications and alternative diagnoses requiring urgent intervention. This retrospective chart review was carried out in 2 ED at an urban university hospital from January to December 2015. All patients with a diagnosis of renal colic were included. The primary outcome was an intervention required for renal colic or alternative diagnoses within 7 days of ED presentation. A stepwise logistic regression was used to assess factors associated with the outcome. A score was derived as a weighted sum of these predictors and its performance was calculated. The database was submitted to the French National Commission for Data Protection and Liberties (CNIL): declaration n°2164898v0 (03/22/2018). 871 with complete data were analyzed. In 94 (11%) patients, an intervention was performed for obstructive urolithiasis or alternative diagnosis. Five factors were most predictive of intervention: age > 45 years (1 point), a history of urologic surgery (1 point), pulse > 100 bpm (1 point), temperature > 37.8 °C (2 point), and urine dipstick negative for blood (1 point), yielding a score of 0–6 points (the Complicated uroLithiasis and Alternative Diagnosis (CLAD) score). The area under the curve of the receiver operating characteristic curve was 0.82 (95% CI 0.77–0.87). We derived a clinical score for renal colic that predicted the presence of obstructive urolithiasis and acute alternative diagnoses requiring intervention.

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Acknowledgements

The authors thank Dr. Azema Olivier for his help with file extraction. The authors thank Dr. Caubet-Kamar Natacha for providing critical revision of the manuscript.

Funding

This work did not require financial support.

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Authors and Affiliations

  1. Emergency Department, Toulouse University Hospital, 31059, Toulouse, France

    Frederic Balen, Marine Bastouil, Sandrine Charpentier, Charles-Henri Houze-Cerfon & Dominique Lauque

  2. Laboratory of Epidemiology and Public Health Analysis, UMR 1027, EQUITY, INSERM, 31000, Toulouse, France

    Frederic Balen & Sandrine Charpentier

  3. Toulouse III, Paul Sabatier University, 31330, Toulouse, France

    Frederic Balen, Sandrine Charpentier & Dominique Lauque

  4. Department of Urology, Kidney Transplant and Andrology, Toulouse University Hospital, 31059, Toulouse, France

    Xavier Game

Authors
  1. Frederic Balen
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  2. Marine Bastouil
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  3. Sandrine Charpentier
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  4. Xavier Game
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  5. Charles-Henri Houze-Cerfon
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  6. Dominique Lauque
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Contributions

FB designed the study, contributed to the acquisition of the database, performed statistical analysis and interpretation of the data, and drafted the manuscript. MB realized the acquisition of the database. SC, XG and CHHC provided critical revision of the manuscript. DL helped to the interpretation of the data and drafted the manuscript.

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Correspondence to Frederic Balen.

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Authors report no conflicts of interest.

Ethical approval

The database was submitted to the French National Commission for Data Protection and Liberties (CNIL): declaration n°2164898v0 (03/22/2018).

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Data were analyzed with Stata software (version 13; StataCorp, College Station, TX).

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Balen, F., Bastouil, M., Charpentier, S. et al. Derivation of a clinical predicting rule for obstructive urolithiasis and alternative diagnosis requiring urgent intervention: the CLAD score. Urolithiasis 49, 145–152 (2021). https://doi.org/10.1007/s00240-020-01191-w

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  • DOI: https://doi.org/10.1007/s00240-020-01191-w

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