title: External validation of a clinical scoring system for hematuria.
abstract: BACKGROUND
  The aim of this study was to evaluate the accuracy of a new scoring system in Korean patients with hematuria at high risk of bladder cancer.
  
  
  METHODS
  A total of 319 consecutive patients presenting with painless hematuria without a history of bladder cancer were analyzed, from the period of August 2012 to February 2014. All patients underwent clinical examination, and 22 patients with incomplete data were excluded from the final validation data set. The scoring system included four clinical parameters: age (≥50 = 2 vs. <50 =1), gender (male = 2 vs. female = 1), history of smoking (smoker/ex-smoker = 4 vs. non-smoker = 2) and nature of the hematuria (gross = 6 vs. microscopic = 2).
  
  
  RESULTS
  The area under the receiver-operating characteristic curve (95% confidence interval) of the scoring system was 0.718 (0.655-0.777). The calibration plot demonstrated a slight underestimation of bladder cancer probability, but the model had reasonable calibration. Decision curve analysis revealed that the use of model was associated with net benefit gains over the treat-all strategy. The scoring system performed well across a wide range of threshold probabilities (15%-45%).
  
  
  CONCLUSIONS
  The scoring system developed is a highly accurate predictive tool for patients with hematuria. Although further improvements are needed, utilization of this system may assist primary care physicians and other healthcare practitioners in determining a patient's risk of bladder cancer.
authors.affiliation: Department of Urology, Seoul National University Boramae Hospital, Seoul, Korea E-mail : kuuro70@snu.ac.kr.
authors.forename: Seung Bae
authors.initials: SB
authors.lastname: Lee
authors.forename: Hyung Suk
authors.initials: HS
authors.lastname: Kim
authors.forename: Myong
authors.initials: M
authors.lastname: Kim
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
mesh_terms: D005260:Female; D006417:Hematuria / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D056910:Republic of Korea / Q000453:epidemiology; D012107:Research Design; D012306:Risk; D018570:Risk Assessment; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology