TOAST classification

Some overlap exists between the clinical classification (Bamford et al. 1991) and the etiological TOAST classification. In a large hospital-based series of patients with ischemic stroke, total and partial anterior circulation infarcts were most likely to be caused by large artery atherosclerosis, cardioembolism or both (Wardlaw et al. 1999). 

Adams HP, Jr., Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE, 3rd. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993 24 35 1. 

Although several approaches to stroke classification have been described, the most common mechanism-based classification in current use is the system described by the TOAST investigators." This classification describes five major subtypes of ischemic stroke based on the results of neuroimaging and other medical investigations, namely (1) LAA, (2) cardioembolism, (3) small-vessel occlusion, (4) stroke of other determined etiology, and (5) stroke of undetermined etiology. Inter-rater reliability of the TOAST scheme has been reported as moderate-to-substantial K 0.5-0.7). 

Using clinical and emergency CT findings, the TOAST investigators found that their initial designation of subtype of stroke matched the final diagnosis in only 62% of patients. No subtype of stroke was more accurately diagnosed than another by initial assessment. In a series of 100 consecutive stroke patients, the accuracy of the initial classification was reported as 1Q% ... 

If that does occur, then the present system of classification of oils may be impossible to police, and a modified system may become necessary. Perhaps the sale and perceived value of oils will necessarily become dependent on the performance, not the source of the oil. With bulk oils such as palm, peanut, sunflower, safflower, sesame, soya, rapeseed, com, fish, and animal fats and oils, the fatty acid composition will obviously be important for health reasons. If the oil is to be used for frying then the frying properties will be important. In the case of palm products the physical properties and minor components such as carotenoids will be defined. Similarly animal fats will be judged mainly on physical behaviour and effect on the product in which they are used. In all cases the oxidative and stability of the oil will have to be defined. Sesame is a very stable oil, and thus its stability, together with its low level of linolenic acid, would be its major attribute, except for toasted sesame, which would probably be classed as a specialist oil. Already most baking fats sold to the public are blends developed to give the best performance, with no mention on the pack as to the source. If a bulk oil of this type had the desired chemical composition, stability and cooking behaviour, then perhaps the source would not be a matter of concern. 

The four main classifications described above (Bamford et al. 1991 Mead et al. 1999) are clinical and can be determined at the bedside and following the results of brain imaging. Further classification is possible in ischemic stroke by etiology, and this is most commonly done according to the TOAST criteria. 

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