title: Multicenter external validation of the ABCD2 score in triaging TIA patients.
abstract: OBJECTIVE
  A simple clinical score (ABCD(2) score) has been introduced to triage TIA patients with a high early risk of stroke. External validation studies have yielded inconsistent results regarding the predictive ability of the ABCD(2) score. We aimed to prospectively validate the former score in a multicenter case series study.
  
  
  METHODS
  We prospectively calculated the ABCD(2) score (age [> or = 60 years: 1 point]; blood pressure [systolic >140 mm Hg or diastolic >90 mm Hg: 1[; clinical features [unilateral weakness: 2, speech disturbance without weakness: 1, other symptom: 0]; duration of symptoms [ <10 minutes: 0, 10-59 minutes: 1, > or = 60 minutes: 2]; diabetes mellitus [yes: 1]) in consecutive TIA patients hospitalized in 3 tertiary care neurology departments across 2 different racial populations (white and Asian).
  
  
  RESULTS
  The 7-day and 90-day risks of stroke in the present case series (n = 148) were 8% (95% CI 4%-12%) and 16% (95% CI 10%-22%). The ABCD(2) score accurately discriminated between TIA patients with high 7-day (c statistic 0.72, 95% CI 0.57-0.88) and 90-day (c statistic 0.75, 95% CI 0.65-0.86) risks of stroke. The 90-day risk of stroke was 7-fold higher in patients with an ABCD(2) score >3 points (28%, 95% CI 18%-38%) than in patients with an ABCD(2) score < or = 3 points (4%, 95% CI 0%-9%). After adjustment for stroke risk factors, race, history of previous TIA, medication use before the index TIA and secondary prevention treatment strategies, an ABCD(2) score of >2 was associated with a nearly 5-fold greater 90-day risk of stroke (hazard ratio 4.65, 95% CI 1.04-20.84, p = 0.045).
  
  
  CONCLUSIONS
  Our findings externally validate the usefulness of the ABCD(2) score in triaging TIA patients with a high risk of early stroke in a multiethnic sample of hospitalized patients. The present data support current guidelines endorsing the immediate hospitalization of patients with an ABCD(2) score >2.
authors.affiliation: Department of Neurology, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece. tsivgoulisgiorg@yahoo.gr
authors.forename: G
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: E
authors.initials: E
authors.lastname: Stamboulis
authors.forename: V K
authors.initials: VK
authors.lastname: Sharma
authors.forename: I
authors.initials: I
authors.lastname: Heliopoulos
authors.forename: K
authors.initials: K
authors.lastname: Voumvourakis
authors.forename: H L
authors.initials: HL
authors.lastname: Teoh
authors.forename: A
authors.initials: A
authors.lastname: Patousi
authors.forename: A
authors.initials: A
authors.lastname: Andrikopoulou
authors.forename: E L
authors.initials: EL
authors.lastname: Lim
authors.forename: L
authors.initials: L
authors.lastname: Stilou
authors.forename: T B
authors.initials: TB
authors.lastname: Sim
authors.forename: B P L
authors.initials: BP
authors.lastname: Chan
authors.forename: L
authors.initials: L
authors.lastname: Stefanis
authors.forename: K
authors.initials: K
authors.lastname: Vadikolias
authors.forename: C
authors.initials: C
authors.lastname: Piperidou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012306:Risk; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D014218:Triage / Q000379:methods*