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TOAST criteria applied in acute ischemic stroke.

B Fure1, T B Wyller, B Thommessen

  • 1Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway. bryfure@online.no

Acta Neurologica Scandinavica
|September 9, 2005
PubMed
Summary

The Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification shows good reliability among junior doctors for acute ischemic stroke. It effectively differentiates small vessel disease, aiding treatment decisions.

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Area of Science:

  • Neurology
  • Clinical Medicine
  • Stroke Research

Background:

  • Accurate etiological subclassification of ischemic stroke is crucial for targeted therapies.
  • The TOAST classification is a key tool for stroke etiology determination.
  • Assessing the reliability and validity of TOAST in the acute setting is essential.

Purpose of the Study:

  • To evaluate the inter-rater reliability of the TOAST classification in acute ischemic stroke.
  • To assess the criterion validity of TOAST in distinguishing small vessel disease from other stroke etiologies.
  • To determine the utility of TOAST in the acute care setting.

Main Methods:

  • 38 patients with acute ischemic stroke were classified using TOAST criteria by two registrars.
  • Initial classifications were compared against a consensus classification derived from comprehensive investigations.

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  • Inter-rater reliability and criterion validity were assessed using kappa statistics, sensitivity, and specificity.

    • Main Results:

    • Excellent inter-rater reliability was observed between the two junior registrars (kappa = 0.88).
    • Fair overall agreement was found between initial and consensus TOAST classifications (kappa = 0.30).
    • The TOAST classification demonstrated high sensitivity (0.93) and specificity (0.83) in differentiating small vessel disease.

    Conclusions:

    • While comprehensive investigation is ideal, TOAST classification is valuable in the acute setting.
    • TOAST aids physicians in differentiating small vessel disease from other acute stroke etiologies.
    • This classification is particularly important when considering therapies with potential adverse effects.