PDF(Pubmed)
Abstract：
UNASSIGNED: The TOAST (Trial of ORG 10172 in Acute Stroke Treatment) is the most commonly used ischemic stroke subtype classification system worldwide and a required field in the US National Get With The Guidelines-Stroke (GWTG-Stroke) registry. However, stroke diagnostics have advanced substantially since the TOAST classification was designed 30 years ago, potentially making it difficult to apply reliably.
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.
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.
摘要：
■TOAST（ORG10172在急性中风治疗中的试验）是全球最常用的缺血性中风亚型分类系统，也是美国国家指南-中风（GWTG-Stroke）注册表中的必填领域。然而,自30年前设计TOAST分类以来，中风诊断已经取得了很大进展，有可能使其难以可靠地应用。
■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。
■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。
