title: Does ABCD2 score below 4 allow more time to evaluate patients with a transient ischemic attack?
abstract: OBJECTIVE
  The National Institute for Clinical Excellence (NICE) recommends that patients with a transient ischemic attack and ABCD(2) score > or =4 and those with >2 transient ischemic attacks within 1 week be admitted for urgent complete etiologic evaluation within 24 hours and that those with an ABCD(2) score <4 be evaluated less urgently within 1 week.
  
  
  METHODS
  Using data from 1176 patients with a definite or possible transient ischemic attack or minor stroke included in the SOS-TIA registry (January 2003 to June 2007), we studied the usefulness of the conventional ABCD(2) score cutoff as well as the NICE criteria for urgent admission to a stroke unit defined as presence of symptomatic internal carotid artery stenosis > or =50%, symptomatic intracranial artery stenosis > or =50%, or major cardiac source of embolism.
  
  
  RESULTS
  Among 697 patients with an ABCD(2) score <4, 20% required immediate consideration for emergency treatment (eg, symptomatic internal carotid stenosis > or =50% in 9.1% of patients, symptomatic intracranial stenosis in 5.0%, atrial fibrillation in 5.9%, other major cardiac source of embolism in 2.1%) in comparison to 31.6% of 497 patients with an ABCD(2) score > or =4. The sensitivity and specificity of ABCD(2) score > or =4 or NICE criteria for discriminating between patients requiring admission or not were <62% with low positive predictive values (<30%) and high negative predictive values (> or =80%).
  
  
  CONCLUSIONS
  One in 5 patients with an ABCD(2) score <4 had high-risk disease requiring urgent treatment decision-making. When triaging on an ABCD(2) score, we recommend adding systematic carotid ultrasound (or a default angiographic CT scan) and electrocardiography within 24 hours before postponing complete transient ischemic attack evaluation.
authors.affiliation: Department of Neurology and Stroke Center, Paris, France. pierre.amarenco@bch.aphp.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Julien
authors.initials: J
authors.lastname: Labreuche
authors.forename: Philippa C
authors.initials: PC
authors.lastname: Lavallée
authors.forename: Elena
authors.initials: E
authors.lastname: Meseguer
authors.forename: Lucie
authors.initials: L
authors.lastname: Cabrejo
authors.forename: Tarik
authors.initials: T
authors.lastname: Slaoui
authors.forename: Céline
authors.initials: C
authors.lastname: Guidoux
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Olivot
authors.forename: Halim
authors.initials: H
authors.lastname: Abboud
authors.forename: Bertrand
authors.initials: B
authors.lastname: Lapergue
authors.forename: Isabelle F
authors.initials: IF
authors.lastname: Klein
authors.forename: Mikael
authors.initials: M
authors.lastname: Mazighi
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Touboul
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000175:diagnosis; D003937:Diagnosis, Differential; D004617:Embolism / Q000175:diagnosis; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D020765:Intracranial Arterial Diseases / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D012042:Registries; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis*