在临床实践中TOAST中风亚型分类:对Get With The Guidelines-Stroke全国注册表的影响
Cecelia M Rathburn1, Katherine T Mun1, Latisha K Sharma1
1Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States.
Frontiers in neurology
|April 8, 2024
概括
对于缺血性中风亚型的ORG 10172在急性中风治疗 (TOAST) 分类中的试验在现实研究中仅显示了61%的准确性. 这凸显了更新分类系统的必要性,以改善中风诊断和护理洞察力.
科学领域:
- 神经学 神经学
- 脑卒中医学 脑卒中医学
- 诊断的准确性 诊断的准确性
背景情况:
- 在急性中风治疗中ORG 10172的试验 (TOAST) 是缺血性中风分类的全球标准.
- 脑卒中诊断已经取得了显著的进步,这可能会限制30年历史的TOAST系统的可靠性.
研究的目的:
- 在现实临床环境中评估当前TOAST分类系统的诊断准确性.
- 将TOAST诊断与从专家审查中得出的参考标准进行比较.
主要方法:
- 49名缺血性中风患者的前性诊断准确性研究.
- 电子医疗记录 (EMR) 中的临床TOAST诊断与EMR和成像专家审查的黄金标准的比较.
- 采用全面的中风准备工作,包括先进的成像和心脏评估.
主要成果:
- 在只有61%的患者 (30/49) 中,TOAST分类与参考标准一致.
- 虽然特异性很高,但对于包括大动脉动脉样硬化 (LAA) 和不确定性 (UND) 在内的几个亚型,灵敏度和积极预测值是次优的.
- 针对LAA (灵敏度33%),其他 (OTH) (灵敏度60%),未确定多重 (UND-M) (灵敏度10%) 和未确定密码 (UND-C) (灵敏度20%) 发现了特定的诊断挑战.
结论:
- 目前的TOAST分类系统在临床实践中表现出有限的准确性,这可能会影响像Get With The Guidelines-Stroke (GWTG-Stroke) 这样的中风注册表的可靠性.
- 需要更新的缺血性中风分类系统,理想情况下通过算法逻辑集成到电子病历中,以提高诊断精度和支持研究.
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