Validation of the STONE and new STONE score for ureteral stones in elderly patients: a retrospective cohort study

Ureteral stones are a common cause of emergency department visits. However, their presentation in older adults may be atypical. As the global population ages, effective and low-risk diagnostic strategies are increasingly vital to improve patient outcomes, reduce radiation exposure, and lower healthcare costs. This retrospective cohort study conducted between January 2020 and December 2024. We aimed to assess the diagnostic performance of the STONE and New STONE scores in detecting ureteral stones among patients aged 60 and older presenting with flank pain. A total of 161 patients who underwent abdominal computed tomography (CT) were included, with ureteral stones detected in 48.4%. Patients with stones had significantly higher STONE (8.7 ± 2.0 vs. 6.1 ± 1.9) and New STONE scores (5.0 ± 1.9 vs. 2.7 ± 1.6) compared to patients without stone (p < 0.001 for both). The STONE score showed an AUC of 0.830 and the New STONE score 0.829. A cut-off STONE score > 5 yielded 97.4% sensitivity, while a cut-off > 9 provided 88.0% specificity. For the New STONE score, a cut-off > 3 offered 89.7% sensitivity, and a cut-off > 6 showed 97.6% specificity. Both scores demonstrated reliable diagnostic accuracy in elderly patients. The STONE score favored sensitivity, while the New STONE score favored specificity. Our findings suggest that these scoring systems may support imaging decision-making and contribute to reducing unnecessary CT exposure and healthcare costs in older adults with suspected ureteral stones.