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

General

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 ABCD score, determined by using clinical factors previously tested on other populations, appears to reliably predict the risk of stroke in the 30 days following hospitalization for transient ischemic attack (TIA). It may not have the same validity in patients not admitted to the hospital. (LOE = 1b)

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.  [PMID:17053179]

Study Design:
Decision rule (validation)

Setting:
Inpatient (any location) with outpatient follow-up

Synopsis:
These authors retrospectively studied 226 consecutive patients hospitalized with TIA. They compared the outcome predicted by the ABCD score with the real outcome. To determine the ABCD (for Age, Blood pressure, Clinical factors, and Duration) score, points are given as follows: 60 years or older (1 point); systolic blood pressure greater than 140 mm Hg and/or diastolic blood pressure greater than or equal to 90 mm Hg (1point); unilateral weakness (2 points), speech disturbance without weakness (1 point); and a duration of symptoms of 60 minutes or more (2 points), of 10 minutes to 59 minutes (1 point), of less than 10 minutes (0 points). The researchers calculating the ABCD score were unaware of the real outcome. Within 30 days of the index TIA, 22 (9.7%) patients had a subsequent stroke. The ABCD score was highly correlated with the risk of stroke: 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.

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