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(Stroke. 2001;32:e1091.)
© 2001 American Heart Association, Inc.

Original Contributions

Appendix TOAST Abstraction Manual TOAST Medical Record Abstraction Manual

	Introduction

 
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 not have 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 sources are 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."
  

• Specific diagnoses
  Mechanical prosthetic heart valve: Record this if explicitly stated in history. May be alternatively described as Starr-Edwards valve (ball and cage device), Medtronic-Hall (single tilting disc 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 mechanical valve 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 . . . [Full Text of this Article]