Ay Hakan, Furie Karen L, Singhal Aneesh, Smith Wade S, Sorensen A Gregory, Koroshetz Walter J
A. A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Ann Neurol. 2005 Nov;58(5):688-97. doi: 10.1002/ana.20617.
Regular, evidence-based assignment of patients to etiologic stroke categories is essential to enable valid comparison among studies. We designed an algorithm (SSS-TOAST) that incorporated recent advances in stroke imaging and epidemiology to identify the most probable TOAST category in the presence of evidence for multiple mechanisms. Based on the weight of evidence, each TOAST subtype was subdivided into 3 subcategories as "evident", "probable", or "possible". Classification into the subcategories was determined via predefined specific clinical and imaging criteria. These criteria included published risks of ischemic stroke from various mechanisms and published reports of the strength of associations between clinical and imaging features and particular stroke mechanisms. Two neurologists independently assessed 50 consecutively admitted patients with acute ischemic stroke through reviews of abstracted data from medical records. The number of patients classified as "undetermined-unclassified" per the original TOAST system decreased from 38-40% to 4% using the SSS-TOAST system. The kappa value for inter-examiner reliability was 0.78 and 0.90 for the original TOAST and SSS-TOAST respectively. The SSS-TOAST system successfully classifies patients with acute ischemic stroke into determined etiologic categories without sacrificing reliability. The SSS-TOAST is a dynamic algorithm that can accommodate modifications as new epidemiological data accumulate and diagnostic techniques advance.
根据循证医学原则将患者常规分配至病因性卒中类别对于实现研究间的有效比较至关重要。我们设计了一种算法（SSS - TOAST），该算法纳入了卒中影像学和流行病学的最新进展，以便在存在多种机制证据的情况下识别最可能的TOAST类别。根据证据权重，将每个TOAST亚型细分为“明确”“很可能”或“可能”3个子类别。通过预定义的特定临床和影像学标准确定子类别分类。这些标准包括已发表的各种机制导致缺血性卒中的风险，以及临床和影像学特征与特定卒中机制之间关联强度的已发表报告。两名神经科医生通过审查病历摘要数据，对50例连续入院的急性缺血性卒中患者进行了独立评估。使用SSS - TOAST系统时，按照原始TOAST系统分类为“未确定 - 未分类”的患者数量从38% - 40%降至4%。原始TOAST和SSS - TOAST的检查者间可靠性kappa值分别为0.78和0.90。SSS - TOAST系统成功地将急性缺血性卒中患者分类到确定的病因类别，且不牺牲可靠性。SSS - TOAST是一种动态算法，可随着新的流行病学数据积累和诊断技术进步而进行调整。
