An evidence-based causative classification system for acute ischemic stroke
An evidence-based causative classification system for acute ischemic stroke
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DOI：
10.1002/ana.20617
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发表时间：
2005-11-01
影响因子：
11.2
通讯作者：
Koroshetz, WJ
中科院分区：
文献类型：
--
作者：
Ay, H;Furie, KL;Koroshetz, WJ
定期、循证地将患者分配到病因学卒中类别对于在研究之间进行有效比较至关重要。我们设计了一种算法（SSS-吐司），该算法结合了卒中成像和流行病学的最新进展，以在存在多种机制证据的情况下确定最可能的吐司类别。根据证据的权重，将每个吐司亚型细分为3个亚类，即“明显”、“可能”或“可能”。通过预定义的特定临床和成像标准确定亚类分类。这些标准包括已发表的各种机制导致缺血性卒中的风险，以及已发表的临床和影像学特征与特定卒中机制之间关联强度的报告。两名神经科医生通过回顾病历中的摘要数据，独立评估了50例连续入院的急性缺血性卒中患者。使用SSS-吐司系统，根据原始吐司系统分类为“未确定-未分类”的患者数量从38-40%降至4%。原始吐司和SSS-吐司的检查者间信度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为确定的病因类别，而不牺牲可靠性。SSS-TOAST是一种动态算法，可以随着新的流行病学数据的积累和诊断技术的进步而进行修改。
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 interexaminer 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 reliabilty. The SSS-TOAST is a dynamic algorithm that can accommodate modifications as new epidemiological data accumulate and diagnostic techniques advance.