ABCD score predicts 7 day stroke risk in patients with TIA

General

Clinical Question:
Does the ABCD score in patients with transient ischemic attacks predict the risk of stroke within 7 days?

Bottom Line:
Patients with a transient ischemic attack (TIA) and an ABCD score of 4 or more were at the greatest risk of developing a stroke within the subsequent 7 days. (LOE = 1a)

Reference:
Sciolla R, Melis F; SINPAC Group. Rapid identification of high-risk transient ischemic attacks: prospective validation of the ABCD score. Stroke 2008;39(2):297-302.  [PMID:18174479]

Study Design:
Decision rule (validation)

Setting:
Emergency department

Synopsis:
The ABCD score is a 6-point scale calculated on the basis of the patient's age (60 years or older= 1 point; younger than 60 years = 0 points); blood pressure (systolic blood pressure at least 140 mm Hg or diastolic blood pressure at least 90 mm Hg = 1 point); clinical features (unilateral weakness = 2 points; speech disturbance without weakness = 1 point; other symptoms = 0 points), and duration of symptoms (60 minutes or greater = 2 points; 10 to 59 minutes = 1 point; less than 10 minutes = 0 points). The scale was developed to predict which patients with TIAs will develop a stroke in the subsequent 7 days. This team of researchers conducted a prospective validation to see how well the score performs. To do this, they prospectively evaluated patients arriving in Italian emergency departments within 24 hours of the onset of TIA symptoms (based on World Health Organization standards). A neurologist conducted a follow-up assessment of patients 1 month after the TIA to ascertain their clinical course. During a 6-month period, the researchers had complete data on 274 consecutively enrolled patients with TIA. During the follow-up period, 2 patients had died and 15 had developed a stroke, 10 of which occurred within 7 days. No patient with an ABCD score of 3 or less had a stroke within 30 days. A total of 20% of the patients with subsequent stroke within 7 days had a score of 4, 40% had score of 5, and 40% had a score of 6.

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