Key result
The CISS system classified significantly fewer minor stroke patients into the undetermined etiology category compared to the TOAST system (6.9% vs 30.3%, P < 0.001) without sacrificing inter-rater reliability.
Why the study?
Does the CISS system improve etiologic classification compared to the TOAST system in patients with minor stroke?
Observational (n=320)
No
Does the CISS system improve etiologic classification compared to the TOAST system in patients with minor stroke?
The CISS system provides reliable etiologic classification for minor stroke and significantly reduces the proportion of undetermined etiology cases compared to the TOAST system.
Both systems show reliable minor stroke classification; leaves open whether CISS improves etiologic assignment in routine practice.
BACKGROUND: The underlying causes of minor stroke are difficult to assess. Here, we evaluate the reliability of the Chinese Ischemic Stroke Subclassification (CISS) system in patients with minor stroke, and compare it to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) system. METHODS: A total of 320 patients with minor stroke were retrospectively registered and categorized into different subgroups of the CISS and TOAST by two neurologists. Inter- and intra-rater agreement with the two systems were assessed with kappa statistics. RESULTS: The percentage of undetermined etiology (UE) cases in the CISS system was 77.3 % less than that in the TOAST system, which was statistically significant (P < 0.001). The percentage of large artery atherosclerosis (LAA) in the CISS system was 79.7 % more than that in the TOAST system, which was also statistically significant (P < 0.001). The kappa values for inter-examiner agreement were 0.898 (P = 0.031) and 0.732 (P = 0.022) for the CISS and TOAST systems, respectively. The intra-observer reliability indexes were moderate (0.569 for neurologist A, and 0.487 for neurologist B). CONCLUSIONS: The CISS and TOAST systems are both reliable in classifying patients with minor stroke. CISS classified more patients into known etiologic categories without sacrificing reliability.
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Tan et al. (2016) conducted an observational in Minor stroke (n=320). Chinese Ischemic Stroke Subclassification (CISS) system vs. Trial of Org 10172 in Acute Stroke Treatment (TOAST) system was evaluated on Percentage of undetermined etiology (UE) cases (p=<0.001). The CISS system classified significantly fewer minor stroke patients into the undetermined etiology category compared to the TOAST system (6.9% vs 30.3%, P < 0.001) without sacrificing inter-rater reliability.
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