UNASSIGNED: In this prospective diagnostic accuracy study, we analyzed consecutive ischemic stroke patients admitted to a Comprehensive Stroke Center between July-October 2021. Clinical practice TOAST classification diagnoses rendered by the stroke team in the electronic medical record (EMR) at discharge were retrieved from GWTG-Stroke registry and compared to a reference (\"gold\") standard diagnosis derived from agreement between two expert raters after review of the EMR and patient imaging.
UNASSIGNED: Among 49 patients; age was 72.3 years (±12.1), 53% female, and presenting NIHSS median 3 (IQR 1-11). Work-up included: brain imaging in 100%; cardiac rhythm assessment in 100%; cervical/cerebral vessel imaging in 98%; TTE ± TEE in 92%; and TCD emboli evaluation in 51%. Reference standard diagnoses were: LAA-6%, SVD-14%, CE-39%, OTH-10%, UND-M (more than one cause)-20%, and UND-C (cryptogenic)-10%. GWTG-Stroke TOAST diagnoses agreed with reference standard diagnoses in 30/49 (61%). Among the 6 subtype diagnoses, specificity was generally high (84.8%-97.7%), but sensitivity suboptimal for LAA (33%), OTH (60%), UND-M (10%), and UND-C (20%). Positive predictive value was suboptimal for 5 of the 6 subtypes: LAA (13%), SVD (58%), OTH (75%), UND-M (50%), and UND-C (50%).
UNASSIGNED: Clinical practice TOAST classification subtype diagnoses entered into the GWTG-Stroke registry were accurate in only 61% of patients, a performance rate that, if similarly present at other centers, would hamper the ability of the national registry to provide dependable insights into subtype-related care. Development of an updated ischemic stroke subtype classification system, with algorithmic logic embedded in electronic medical records, is desirable.
■在这项前瞻性诊断准确性研究中,我们分析了2021年7月至10月在综合卒中中心收治的连续缺血性卒中患者.临床实践从GWTG-Stroke注册表中检索了出院时卒中团队在电子病历(EMR)中提供的TOAST分类诊断,并将其与参考(“黄金”)标准诊断进行比较,该诊断是根据两位专家之间的协议得出的。EMR和患者影像学检查。
■在49例患者中;年龄为72.3岁(±12.1),53%女性,并呈现NIHSS中位数3(IQR1-11)。检查包括:脑成像100%;心律评估100%;颈部/脑血管成像98%;TTE±TEE92%;TCD栓塞评估51%。参考标准诊断为:LAA-6%,SVD-14%,CE-39%,OTH-10%,UND-M(不止一种原因)-20%,和UND-C(隐源性)-10%。GWTG-卒中TOAST诊断与参考标准诊断在30/49(61%)中一致。在6个亚型诊断中,特异性普遍较高(84.8%-97.7%),但LAA的灵敏度次优(33%),OTH(60%),UND-M(10%),和UND-C(20%)。6种亚型中的5种的阳性预测值次优:LAA(13%),SVD(58%),OTH(75%),UND-M(50%),和UND-C(50%)。
■临床实践输入GWTG-卒中登记的TOAST分类亚型诊断仅在61%的患者中准确,性能率,如果类似地存在于其他中心,会妨碍国家登记处对亚型相关护理提供可靠见解的能力。更新的缺血性卒中亚型分类系统的发展,在电子病历中嵌入算法逻辑,是可取的。