Kidney STONE Score Decision Guide

Decision guide and clinical suggestions The STONE score is a clinical prediction rule to estimate probability of uncomplicated ureteral stone based on five clinical items. The original computed score ranges from 0 to 13. The modified score excludes the origin component and ranges from 0 to 10.

For an original STONE score in the high probability range ten to thirteen and for a modified STONE score in the high range nine to ten clinicians may consider targeted imaging with point of care ultrasonography or reduced dose CT depending on local availability and clinical status. Provide adequate analgesia and arrange urology referral if indicated. For moderate probability consider imaging guided by clinical judgment.

For low probability consider alternative diagnoses and conservative management with close follow up. Use clinical judgment and local resources to decide imaging strategies. STONE is a supplementary tool and does not replace clinical evaluation.

Consider additional factors such as vital signs, fever, renal function, and suspicion of alternative serious diagnosis when making final decisions. Reference Moore CL et al derivation and validation BMJ 2014 and related validation literature. See also MDCalc STONE score summary and external validation in Annals of Emergency Medicine.

European urology guidance on imaging and recent systematic reviews discuss performance and limitations of the rule. Selected references for clinicians Moore CL et al Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone BMJ 2014. MDCalc STONE Score for Uncomplicated Ureteral Stone.

Wang RC et al External validation Annals of Emergency Medicine 2016. Dahm P et al Systematic review and meta analysis 2022. EAU Guidelines on Urolithiasis.