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Appendix TOAST Abstraction Manual TOAST Medical Record Abstraction Manual Stroke. 2001;32:e1091-e1098 doi: 10.1161/01.STR.32.5.e1091
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Appendix Appendix TOAST Abstraction Manual TOAST Medical Record Abstraction Manual
Section 1A. History/Emboli ● General precepts ­ All noted historical information must occur prior to index stroke admission. If a diagnosis is found within the discharge summary, it must nothave been diagnosed during the index admission. It is often best to consult the admission history and physical for complete past medical history rather than discharge summary. ­ You may wish to circle (or otherwise denote) presence of all applicable conditions. If both high risk and medium risk sources occur, score the section as “[1]— high risk source for emboli.” If multiple medium risk sourcesare present (but no high risk), the section is scored “[2]—medium risk source for emboli.” If no high or medium risk sources are present, score the question “[3]—No source for emboli.”
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Specific diagnoses ­ Mechanical prosthetic heart valve: Record this if explicitly stated in history. May be alternatively described as StarrEdwards valve (ball and cage device), Medtronic-Hall (single tiltingdisc valve) or St. Jude Medical model (bi-leaflet valve). Bioprosthetic valves (e.g. porcine) are not considered high risk (see below) so it is important to distinguish between the types of valve replacements when possible. If it is stated that the person has a valve replacement (or prosthetic valve) but this is not further described keep the following in mind: (1) All persons with a mechanicalvalve of any sort should be anticoagulated before admission (usually with coumadin). However, persons with bioprosthetic valves sometimes require anticoagulation. (2) Persons with mechanical valve may be described as having a ‘clink’ or metallic heart sound on cardiac physical exam. (3) All mechanical heart valves should be visible on chest x-ray (or echo) and appropriately described. (4) If the typeof valve remains ambiguous after the following consideration, consider it a bioprosthetic valve and score it under [2]—“Medium risk source for emboli.” ­ Atrial fibrillation: Score this response if the patient has a documented history of any episode of atrial fibrillation prior to admission. Score even if the patient is being treated with anticoagulation (e.g. coumadin), antiarrhythmics (e.g.digoxin, calcium channel blockers, beta-blockers), has a pacemaker, or has been successfully undergone cardioversion in the past. Do not score other forms of supraventricular tachycardia or conduction abnormalities (e.g. multifocal atrial tachycardia, Wolff-Parkinson-White syndrome) ­ Sick-sinus syndrome: Score this response if patient has history of sick-sinus syndrome, even if being treated with...