Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack?
OBJECTIVE
A 6-point scoring system (ABCD) was described recently for stratifying risk after transient ischemic attack (TIA). This score incorporates age (A), blood pressure (B), clinical features (C), and duration (D) of TIA. A score <4 reportedly indicates minimal short-term stroke risk. We evaluated this scoring system in an independent population.


METHODS
This was a prospective study of TIA patients (diagnosed by a neurologist using the classic <24-hour definition) hospitalized <48 hours from symptom onset. The primary outcome assessment consisted of dichotomization of patients into 2 groups. The high-risk group included patients with stroke or death within 90 days, > or =50% stenosis in a relevant artery, or a cardioembolic source warranting anticoagulation. All others were classified as low risk. Findings on diffusion-weighted MRI (DWI) were also evaluated when performed and patients classified as DWI+ or DWI-.


RESULTS
Over 3 years, 117 patients were enrolled. Median time from symptom onset to enrollment was 25.2 hours (interquartile range 19.8 to 30.2). Overall, 26 patients (22%) were classified as high risk, including 2 strokes, 2 deaths, 15 with > or =50% stenosis, and 10 with cardioembolic source. The frequency of high-risk patients increased with ABCD score (0 to 1 13%; 2 8%; 3 17%; 4 27%; 5 26%; 6 30%; P for trend=0.11). ABCD scores in the 2 patients with stroke were 3 and 6. Of those who underwent MRI, 15 of 61 (25%) were DWI+, but this correlated poorly with ABCD score (0 to 1 17%; 2 10%; 3 36%; 4 24%; 5 13%; 6 60%; P for trend=0.24).


CONCLUSIONS
Although the ABCD score has some predictive value, patients with a score <4 still have a substantial probability of having a high-risk cause of cerebral ischemia or radiographic evidence of acute infarction despite transient symptoms.
Cucchiara
Brett L
BL
Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. cucchiar@mail.med.upenn.edu
Messe
Steve R
SR
Taylor
Robert A
RA
Pacelli
James
J
Maus
Douglas
D
Shah
Qaisar
Q
Kasner
Scott E
SE
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001281:Atrial Fibrillation / Q000150:complications / Q000453:epidemiology; D015415:Biomarkers; D001794:Blood Pressure; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D020766:Intracranial Embolism / Q000453:epidemiology / Q000209:etiology; D002546:Ischemic Attack, Transient / Q000145:classification* / Q000453:epidemiology / Q000209:etiology; D007806:Language Disorders / Q000209:etiology; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D019851:Thrombophilia / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D013997:Time Factors
D015415:Biomarkers