Clinical Health Updates

ABCD rule predicts 7- and 30-day stroke risk in pts with TIA

Clinical Question:
Do clinical factors reliably predict which patients with transient ischemic attacks will experience a stroke in the next 30 days?

Bottom Line:
The findings validate the predictive value of the ABCD score in identifying hospitalized TIA patients with a high risk of early stroke and provide further evidence for its potential applicability in clinical practice.

Tsivgoulis G, Spengos K, Manta P, et al. Validation of the ABCD score in identifying individuals at high early risk of stroke after a transient ischemic attack: a hospital-based case series study. Stroke 2006;37:2892-2897.

Study Design:
Decision rule (validation)

A simple score derived in the Oxfordshire Community Stroke Project (ABCD score) was able to identify individuals at high early risk of stroke after a transient ischemic attack (TIA) both in a population-based and a hospital-referred clinic cohort. The authors aimed to further validate the former score in a cohort of hospitalized TIA patients. They retrospectively reviewed the emergency room and hospital records of consecutive patients hospitalized in our neurological department with a definite TIA according to the World Health Organization (WHO) criteria during a 5-year period. The 6-point ABCD score (age [<60 years=”0,”> or =60 years=1]; blood pressure [systolic < or =”140″ or =”90″ hg=”0,”>140 mm Hg and/or diastolic >90 mm Hg=1]; clinical features [unilateral weakness=2, speech disturbance without weakness=1, other symptom=0]; duration of symptoms [<10 minutes=”0,” minutes=”1,”> or =60 minutes=2]) was used to stratify the 30-day stroke risk.
ABCD score 7-day stroke risk (95% CI) 30-day stroke risk (95% CI)
2 or less 0 0
3 1.7% (0%-5.1%) 3.5% (0%-8.2%)
4 7.6% (1.2%-14%) 7.6% (1.2%-14%)
5 19.1% (7.8%-30.4%) 21.3% (10.4%-33%)
6 18.8% (0%-37.9%) 31.3% (8.6%-54%)

There is one limitation to this generally well-done study: The ABCD model was developed in an outpatient setting to predict risk for all TIA patients. This study only addresses its application to hospitalized patients.