[Lack of usefulness of ABCD score in the early risk of recurrent stroke in transient ischemic attack patients].
OBJECTIVE
Recently a clinical score (ABCD) to identify individuals at high seven-day risk of stroke after transient ischemic attack (TIA) was proposed. The aim of this study was to test this clinical model.


METHODS
We validated the ABCD score (age > or = 65 years = 1; hypertension = 1; unilateral weakness = 2, speech disturbance without weakness = 1, duration of symptoms in minutes > or = 60 = 2; 10-59 = 1; < 10 = 0) in 325 consecutive TIA patients. Clinical data, symptoms duration, CT scan, and ultrasonographic (carotid and transcranial) findings were collected. Seven-day risk of stroke was recorded.


RESULTS
A total of 16 (4.9%) patients had a stroke recurrence within the first seven days after symptoms onset. Six out of 16 (37.5%) strokes occurred in 115 (35.4%) patients with a score of 5 or greater, while the 7-day risk was 4.8% (95% CI 2.04-7.56) in 210 (63.5%) patients with a score less than 5. In cox proportional hazards multivariate analyses only large-artery occlusive disease remained an independent predictor of stroke recurrence [hazard ratio = 5.66 (95% CI 2.06-15.57; p = 0.001)].


CONCLUSIONS
Clinical data are not enough to identify patients at higher risk. The combination of clinical, radiological and vascular information may improve the predictive accuracy of stroke recurrence risk. The routine use of combined carotid/transcranial ultrasound testing performed early will be useful for identifying high risk individuals in order to plan urgent aggressive prevention therapies.
Purroy García
Francisco
F
Sección de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España. 34271fpg@comb.es
Molina Cateriano
Carlos Alberto
CA
Montaner Villalonga
Joan
J
Delgado Martínez
Pilar
P
Santmarina Pérez
Esteban
E
Toledo
Manuel
M
Quintana
Manuel
M
Alvarez Sabín
José
J
D000368:Aged; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*; D013997:Time Factors