Validating the ABCD(2) Score for predicting stroke risk after transient ischemic attack in the ED.
OBJECTIVE
The aim of the study was to validate the use of the ABCD(2) score for the prediction of stroke after transient ischemic attack (TIA) in patients presenting to the emergency department (ED). The ABCD(2) scoring is based on 5 factors as follows: age of at least 60 years; blood pressure of at least 140/90 mm Hg; clinical features such as unilateral weakness and speech impairment alone; duration of at least 60 minutes or 10 to 59 minutes; and diabetes.


METHODS
The authors conducted a retrospective observational study of all patients presented to the ED for TIA, as diagnosed by the attending emergency physicians, for a 2-year period. Sensitivity, specificity, and negative predictive value (NPV) were calculated for risk of stroke at 2, 7, 30, and 90 days after presentation.


RESULTS
From January 1, 2005, to December 31, 2006, there were 470 patients diagnosed with TIA at the ED. Mean age was 61.0 years (SD, 13.2), with 63.3% males. Age of at least 60 years, unilateral weakness, and duration of at least 60 minutes were found to be significant predictors of stroke at 2 days. An admission rule based on an ABCD(2) score of at least 4 showed sensitivity of 86.4% and NPV of 91.7% for stroke at 7 days. Admission based on a score of at least 3 showed sensitivity of 96.6% and NPV of 96.1%. Admission rate was 69.1% and. 83.6%, respectively.


CONCLUSIONS
The ABCD(2) rule showed good sensitivity and NPV for stroke at 7 days. However, NPV was not 100%, and there would still be patients being discharged from the ED and returning with a stroke if this cutoff was implemented in our setting.
Ong
Marcus Eng Hock
ME
Department of Emergency Medicine, Singapore General Hospital, 169608, Singapore. marcus.ong.e.h@sgh.com.sg
Chan
Yiong Huak
YH
Lin
Wan Ping
WP
Chung
Wan Ling
WL
D000367:Age Factors; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors