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.

Reference:
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)

Synopsis:
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.