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.
RCT Entities:
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.
Authors: Bradford Burke Worrall; Devin L Brown; Thomas G Brott; Robert D Brown; Scott L Silliman; James F Meschia Journal: Neuroepidemiology Date: 2003 Jul-Aug Impact factor: 3.282
Authors: E M Arsava; E Ballabio; T Benner; J W Cole; M P Delgado-Martinez; M Dichgans; F Fazekas; K L Furie; K Illoh; K Jood; S Kittner; A G Lindgren; J J Majersik; M J Macleod; W J Meurer; J Montaner; A A Olugbodi; A Pasdar; P Redfors; R Schmidt; P Sharma; A B Singhal; A G Sorensen; C Sudlow; V Thijs; B B Worrall; J Rosand; H Ay Journal: Neurology Date: 2010-10-05 Impact factor: 9.910
Authors: H Baradaran; P Patel; G Gialdini; A Giambrone; M P Lerario; B B Navi; J K Min; C Iadecola; H Kamel; A Gupta Journal: AJNR Am J Neuroradiol Date: 2017-07-20 Impact factor: 3.825
Authors: Joan Montaner; David Salat; Teresa García-Berrocoso; Carlos A Molina; Pilar Chacón; Marc Ribó; José Alvarez-Sabín; Anna Rosell Journal: Transl Stroke Res Date: 2010-08-28 Impact factor: 6.829
Authors: Andre D Kumar; Amelia K Boehme; James E Siegler; Michael Gillette; Karen C Albright; Sheryl Martin-Schild Journal: J Stroke Cerebrovasc Dis Date: 2012-09-30 Impact factor: 2.136