Author(s): Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB
Background and Purpose: The etiology of ischemic stroke affects prognosis, outcome, and management. Trials of therapies for patients with acute stroke should include measurements of responses as influenced by subtype of ischemic stroke. A system for categorization of subtypes of ischemic stroke mainly based on etiology has been developed for the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Methods: A classification of subtypes was prepared using clinical features and the results of ancillary diagnostic studies. "Possible" and "probable" diagnoses can be made based on the physician's certainty of diagnosis. The usefulness and interrater agreement of the classification were tested by two neurologists who had not participated in the writing of the criteria. The neurologists independently used the TOAST classification system in their bedside evaluation of 20 patients, first based only on clinical features and then after reviewing the results of diagnostic tests. Results: The TOAST classification denotes five subtypes of ischemic stroke: 1) large-artery atherosclerosis, 2) cardioembolism, 3) small-vessel occlusion, 4) stroke of other determined etiology, and 5) stroke of undetermined etiology. Using this rating system, interphysician agreement was very high. The two physicians disagreed in only one patient. They were both able to reach a specific etiologic diagnosis in 11 patients, whereas the cause of stroke was not determined in nine. Conclusions: The TOAST stroke subtype classification system is easy to use and has good interobserver agreement. This system should allow investigators to report responses to treatment among important subgroups of patients with ischemic stroke. Clinical trials testing treatments for acute ischemic stroke should include similar methods to diagnose subtypes of stroke.
Referred From: http://stroke.ahajournals.org/content/24/1/35.full.pdf+html
Author(s): Ott A, Breteler MM, de Bruyne MC, van Harskamp F, Grobbee DE
Author(s): Wolf PA, Abbott RD, Kannel WB
Author(s): Furberg CD, Psaty BM, Manolio TA, Gardin JM, Smith VE
Author(s): Wagner KH, Brath H
Author(s): Rizzo JA, Mallow P, Waters H, Cirrincione A
Author(s): Jorgensen HS, Nakayama H, Reith J, Raaschou HO, Olsen TS
Author(s): Fuster V, Ryden LE, Asinger RW, Cannom DS, Crijns HJ
Author(s): Benjamin EJ, Levy D, Vaziri SM, D\'Agostino RB, Belanger AJ
Author(s): Tsang TS, Petty GW, Barnes ME, O\'Fallon WM, Bailey KR
Author(s): Steger C, Pratter A, Martinek-Bregel M, Avanzini M, Valentin A
Author(s): Thom T, Haase N, Rosamond W, Howard VJ, Rumsfeld J,
Author(s): Ball J, Carrington MJ, McMurray JJ, Stewart S
Author(s): Glader EL, Stegmayr B, Norrving B, Terént A, Hulter-Asberg K
Author(s): Sinner MF, Ellinor PT, Meitinger T, Benjamin EJ, Kääb S
Author(s): Dewland TA, Olgin JE, Vittinghoff E, Marcus GM
Author(s): Hernandez MB, Asher CR, Hernandez AV, Novaro GM
Author(s): Gan R, Sacco RL, Kargman DE, Roberts JK, Boden-Albala B
Author(s): Ruigomez A, Johansson S, Wallander MA, Rodriguez LA
Author(s): Stewart S, Hart CL, Hole DJ, McMurray JJ
Author(s): Psaty BM, Manolio TA, Kuller LH, Kronmal RA, Cushman M
Author(s): Barnes ME, Miyasaka Y, Seward JB, Gersh BJ, Rosale s AG
Author(s): Dulli DA, Stanko H, Levine RL
Author(s): Lamassa M, Di Carlo A, Pracucci G, Basile AM, Trefoloni G
Author(s): Lin HJ, Wolf PA, Kelly-Hayes M, Beiser AS, Kase CS
Author(s): Friberg J, Buch P, Scharling H, Gadsbphioll N, Jensen GB
Author(s): Kim MH, Lin J, Hussein M, Battleman D
Author(s): Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR,
Author(s): Wattigney WA, Mensah GA, Croft JB
Author(s): Keogh AM, Baron DW, Hickie JB
Author(s): Markides V, Schilling RJ