Aplicación de los sistemas TOAST y CCS en el diagnóstico de accidente cerebrovascular isquémico

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.