medigraphic.com
ISSN 0028-3851 (Print)

2019, Number 1

<< Back Next >>

Rev Neurol Neurocir Psiquiat 2019; 47 (1)

Application of the TOAST and CCS systems in the diagnosis of ischemic stroke

Martín F, Tarducci ME, Tabares SM, Martín JJ, Sembaj A

Language: Spanish
References: 14
Page: 22-28
PDF size: 260.87 Kb.


ABSTRACT

Introduction: We propose to compare the diagnostic efficiency of the TOAST and the CCS classification systems in patients with stroke who attend at the Sanatorium Allende, Cordoba. Material and methods: The TOAST and CCS classification systems were applied to 100 patients who were admitted to the Neurology Service of the Sanatorium Allende, from the data of the clinical records in a retrospective way. To the diagnostic efficiency of both types of classification was analyzed by kappa index. Results: According to CCS 3 (3%) of the patients were undetermined etiology, 10 (10%) other cryptogenic causes, 2 (2%) not determined known / cryptogenic embolic and 5 (5%) undetermined etiology/incomplete evaluation, totaling 20 (20%); according to TOAST 39 (39%) of the patients were of indeterminate etiology. There was a very good diagnostic agreement between the subtypes assigned by TOAST and the CCS (Κ = 0.81). For the main subtypes the agreement was also very good: large vessel atherosclerosis (k = 0.898), small artery occlusion (k = 0.98), cardioembolism (k = 0.95), others causes (k = 0.88). Moderate agreement was observed for the indeterminate category (k = 0.564). Conclusion: The CCS system showed to be more efficient to determine the etiology of the ICVA compared to the TOAST. Also, is it a web algorithm increases the reliability among evaluators.


REFERENCES

  1. Desai JA, Abuzinadah AR, Imoukhuede O, Bernbaum ML, Modi J, Demchuk AM et al. Etiologic classification of TIA and minor stroke by A-S-C-O and causative classification system as compared to TOAST reduces the proportion of patients categorized as cause undetermined. Cerebrovasc Dis. 2014; 38: 121-126.

  2. Ay H, Benner T, Arsava EM, Furie KL, Singhal AB, Jensen MB et al. A computerized algorithm for etiologic classification of ischemic stroke: The Causative Classification of Stroke System. Stroke. 2007; 38: 2979-2984.

  3. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al. Classification of subtype of acute ischemic stroke. Definitions for use in a Stroke. multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24 (1): 35-41.

  4. Lanfranconi S, Markus HS. Stroke subtyping for genetic association studies? A comparison of the CCS and TOAST classifications. Int J Stroke. 2013; 8: 626-631.

  5. McArdle PF, Kittner SJ, Ay H, Brown RD Jr, Meschia JF, Rundek T et al. Agreement between TOAST and CCS ischemic stroke classification: the NINDS SiGN study. Neurology. 2014; 28: 1653-1660.

  6. Marnane M, Duggan CA, Sheehan OC, Merwick A, Hannon N, Curtin D et al. Stroke subtype classification to mechanism-specific and undetermined categories by TOAST, A-S-C-O, and causative classification system: direct comparison in the North Dublin population stroke study. Stroke. 2010; 42: 1579-1586.

  7. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OP, Bambakidis NC, Becker K et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49: e46-e110.

  8. López-de Ullibarri GI, Pita-Fernández S. Medidas de concordancia: el índice kappa en metodología de la investigación Unidad de Epidemiología Clínica y Bioestadística. Complexo Hospitalario Universitario de A Coruña (España). Cad Aten Primaria. 1999; 6: 169-171.

  9. Arsava EM, Ballabio E, Benner T, Cole JW, Delgado-Martinez MP, Dichgans M et al. The Causative classification of stroke system: an international reliability and optimization study. Neurology. 2010; 75: 1277-1284.

  10. Saposnik G, Del Brutto OH; Iberoamerican Society of Cerebrovascular Diseases. Stroke in South America: a systematic review of incidence, prevalence, and stroke subtypes. Stroke. 2003; 34: 2103-2107.

  11. Rojas JI, Zurru MC, Patrucco L, Romano M, Riccio PM, Cristiano E. Registro de enfermedad cerebrovascular isquémica. Medicina (Buenos Aires). 2006; 66: 547-551.

  12. Sposato LA, Esnaola MM, Zamora R, Zurrú MC, Fustinoni O, Saposnik G; ReNACer Investigators; Argentinian Neurological Society. Quality of ischemic stroke care in emerging countries: the Argentinian National Stroke Registry (ReNACer). Stroke. 2008; 39 (11): 3036-41.

  13. Gokcal E, Niftallyev E, Asil T. Etiological classification of ischemic stroke in young patients: a comparative study of TOAST, CCS and ASCO. Acta Neurol Belg. 2017; 117: 643-648.

  14. Bogiatzi C, Wannarong T, McLeod AI, Heisel M, Hackam D, Spence JD. SPARKLE (Subtypes of Ischaemic Stroke Classification System), incorporating measurement of carotid plaque burden: a new validated tool for the classification of ischemic stroke subtypes. Neuroepidemiology. 2014; 42: 243-251.




2020     |     www.medigraphic.com