Journal Club Summary

Methodology Score: 2.5/5                
Usefulness Score:  2/5
Moore CL, Bomann S, Daniels B, Luty S, Molinaro A, Singh D, Gross CP.
BMJ. 2014 Mar 26;348:g2191.
This study derived and validated an objective clinical prediction rule which found that a ureteral stone was present in 9.2% of the low score group, 51.3% of the moderate score group, and 88.6% of the high score group while an acutely alternative finding was present in 1.6% of the high score group. The group was very critical of the study methodology as well as a scoring tool utilizing ethnicity as one of five criteria; the clinical utility of the STONE score was felt to be very limited in our local practice. 
By: Dr. Nicholas Costain
(Presented November 2014)

Epi lesson: Major Steps in the Development of a Clinical Decision Rule 

The first step entails a derivation study that ideally is conducted prospectively and has a large number of outcome cases. The second step is a prospective validation study that explicitly evaluates the new rule for accuracy, physician acceptability and potential impact. The third step is an implementation trial to evaluate the actual impact of the rule on patient outcomes in real clinical practice.  
By: Dr. Ian Stiell