The Comparative Study Of Classification About Ischemic Stroke According To OCSP And TOAST Criteria

Objective: To analysis the proportion and clinical feature of ischemic stroke subtypes according to the OCSP and TOAST criteria.To make a comparison about the two classification consistency and accuration.To investigate their clinical application value of the two classification by analyzing the patient's condition and judging the prognosis of the acute ischemic stroke inpatients .Methods: Data was prospectively collected from 520 consecutive ischemic stroke inpatients in our departments from 1 August 2004 to 31 January 2007. All included inpatients were firstly classified into different subtypes based on the clinical situation and image diagnose when they were on admission, according to the OCSP and TOAST criteria.When leaving hospital,all inpatients were classified secondly based on their ancillary diagnostic studies to make a comparison and analysis the proportion,the neurological impairment score,improvement rate,circatrigintan death rate of different subtypes inpatients. We tried to find the relationship between the clinical situation and prognosis and make a comparison about their consistency and accuration of the two classification about the OCSP and TOAST classification .Results:1.Five hundred and twenty inpatients were included in the study. The proportion of the different ischemic stroke subtypes according to OCSP criteria was as follows: total anterior circulation infarcts 18.3% , partial anterior circulation infarcts 26.5%, lacunar infarcts 41.0%, posterior circulation infarcts 14.0% ; The proportion of the different ischemic stroke subtype according to TOAST criteria was as follows: cardio embolism 9.5%, large artery atherosclerosis 24.7% , small artery occlusion lacunare 42.6%, other demonstrated etiology 2.8%,undetermined etiology 20.4%.2. The study on the relationship between the two classification shows that the main etiological factor of ischemic stroke subtypes according to the OCSP criteria was as follows:TACI corresponds to LAA(51.6%) and CE(33.7%);PACI corresponds to SAO ( 36.2% ), SUE(26.8%) and LAA(24.6%);POCI corresponds to SUE(33.8%)and LAA(31.1%);LACI corresponds to SAO(69.1%).3.The most ischemic stroke inpatients(68.0%) could not visit the hospital in six hours after onset.The visiting rate of total anterior circulation infarcts was the highest of all subtyes.4.The study on the 520 patients, condition and prognosis shows that:In OCSP,TACI inpatients have the highest neurologic impairment score than the other three subtypes. There were great differences(p=0.000).LACI inpatients have the highest improvement rate among all stroke subtypes. There were great differences( p=0.001) .In TOAST ,CE inpatients have the highest neurologic impairment score on admission of the all subtypes. There were great differences(P=0.000<0.01).SAO inpatients have the highest improvem- ent rate among the all subtypes. There were great differences(P=0.000).Acco- rding to the following-up visiting them for a month,total mortality rate was 3.9%.The mortality rate of every subtype was as follows: TACI 14.7%,PACI 2.2%,LACI 0.0%,POCI 4.0%. The mortality rate of the TACI inpatients was higher than the others.In TOAST,the mortality rate of every subtype was as follows:CE20.4%,LAA3.1%,SAO0.9% SUE3.8%,SDE0.0%.The mortality of CE inpatients was significantly higher than the others. There were great differences(P=0.000<0.01).5.The study on 520 ischemic stroke inpatients with detailed results of image diagnoses shows that there were 466 patients whose OCSP classificati- on consistented with the last image diagnose, 54 inpatients were not. Total accuration rate was 89.6%,K=0.873,which was high consistency.The diagno- stic accuration of every subtype was TACI 97%,PACI 86% ,LACI 90% ,POCI 80%.There were great differences ( p=0.034<0.05 ) .We made second classification by completing 260 inpatients, ancillary diagnostic when leaving hospital ,who according to the TOAST criteria. 94 inpatients enrolled in the trial. 166 (63.8%)inpatients agreed with each other finally.The rate was medium and similar to all stroke subtypes (K= 0.418) .Conclusions:1.The OCSP classification was a method which based on the clinical situation of patients,not depended on supplementary diagnose. It has the high consistency of both the OCSP classification and the last image diagnose.As an classification method,it could early provide the information about individualized treatment of the ischemic stroke inpatients.2.The TOAST classification could predict the exact cause of diseases.It was a good etilogical classification. But it could contribute to the choice of etilogical treatment and secondary prevention of ischemic stroke.