Evaluation of STONE, modified STONE, and CHOKAI scores for predicting ureteric stone disease in Indian emergency patients: A prospective observational study

Milan Manu; Naman Agrawal; Roshan Mathew; Saroj Kumar Pati; Amit Kumar Mishra; Debendra Kumar Tripathy

doi:10.4103/tjem.tjem_277_25

Milan Manu¹, Naman Agrawal¹, Roshan Mathew¹, Saroj Kumar Pati², Amit Kumar Mishra³, Debendra Kumar Tripathy¹

¹Department of Trauma and Emergency, All India Institute of Medical Science, Raipur, Chhattisgarh, India
²Department of Radiology, All India Institute of Medical Science, Raipur, Chhattisgarh, India
³Department of Community Medicine, All India Institute of Medical Science, Raipur, Chhattisgarh, India

Keywords: Abdominal pain, scores, urolithiasis

Abstract

OBJECTIVE: Acute flank pain is a common complaint in the emergency department (ED), with urolithiasis being a major cause. This prospective observational study evaluated the performance of the STONE, modified STONE, and CHOKAI scores in predicting ureteric stones in Indian ED patients with acute flank pain.

METHODS: The study included adult patients who underwent noncontrast computed tomography for suspected urolithiasis. Clinical scores were calculated independently, and their diagnostic accuracy was assessed using receiver operating characteristic (ROC) curve analysis.

RESULTS: Ureteric stones were diagnosed in 58.3% of the patients. The CHOKAI score demonstrated the highest accuracy (area under the curve [AUC] 0.89), followed by the modified STONE (AUC 0.84) and STONE (AUC 0.65) scores. Optimal cutoffs were identified using Youden’s index. DeLong’s test revealed that CHOKAI and modified STONE scores outperformed the STONE score, while the difference between CHOKAI and modified STONE was not significant. The Hosmer–Lemeshow test showed good calibration for the CHOKAI and modified STONE scores.

CONCLUSIONS: The CHOKAI score demonstrated the highest diagnostic accuracy in our cohort and may be the preferred tool for predicting ureteric stones in this clinical setting. Further validation in larger multicenter studies is warranted.

How to cite this article: Manu M, Agrawal N, Mathew R, Pati SK, Mishra AK, Tripathy DK. Evaluation of STONE, modified STONE, and CHOKAI scores for predicting ureteric stone disease in Indian emergency patients: A prospective observational study. Turk J Emerg Med 2026;26:55-61.