title: Optimizing the risk estimation after a transient ischaemic attack - the ABCDE⊕ score.
abstract: OBJECTIVE
  The risk of stroke after a transient ischaemic attack (TIA) can be predicted by scores incorporating age, blood pressure, clinical features, duration (ABCD-score), and diabetes (ABCD2-score). However, some patients have strokes despite a low predicted risk according to these scores. We designed the ABCDE+ score by adding the variables 'etiology' and ischaemic lesion visible on diffusion-weighted imaging (DWI) -'DWI-positivity'- to the ABCD-score. We hypothesized that this refinement increases the predictability of recurrent ischaemic events.
  
  
  METHODS
  We performed a prospective cohort study amongst all consecutive TIA patients in a university hospital emergency department. Area under the computed receiver-operating curves (AUCs) were used to compare the predictive values of the scores with regard to the outcome stroke or recurrent TIA within 90 days.
  
  
  RESULTS
  Amongst 248 patients, 33 (13.3%, 95%-CI 9.3-18.2%) had a stroke (n = 13) or a recurrent TIA (n = 20). Patients with recurrent ischaemic events more often had large-artery atherosclerosis as the cause for TIA (46% vs. 14%, P < 0.001) and positive DWI (61% vs. 35%; P = 0.01) compared with patients without recurrent events. Patients with and those without events did not differ with regard to age, clinical symptoms, duration, blood pressure, risk factors, and stroke preventive treatment. The comparison of AUCs [95%CI] showed superiority of the ABCDE+ score (0.67[0.55-0.75]) compared to the ABCD(2) -score (0.48[0.37-0.58]; P = 0.04) and a trend toward superiority compared to the ABCD-score (0.50[0.40-0.61]; P = 0.07).
  
  
  CONCLUSIONS
  In TIA patients, the addition of the variables 'etiology' and 'DWI-positivity' to the ABCD-score seems to enhance the predictability of subsequent cerebral ischaemic events.
authors.affiliation: Stroke Unit and Department of Neurology, University Hospitals Basel, Petersgraben, Basel, Switzerland. sengelter@uhbs.ch
authors.forename: S T
authors.initials: ST
authors.lastname: Engelter
authors.forename: M
authors.initials: M
authors.lastname: Amort
authors.forename: F
authors.initials: F
authors.lastname: Jax
authors.forename: F
authors.initials: F
authors.lastname: Weisskopf
authors.forename: M
authors.initials: M
authors.lastname: Katan
authors.forename: A
authors.initials: A
authors.lastname: Burow
authors.forename: L H
authors.initials: LH
authors.lastname: Bonati
authors.forename: F
authors.initials: F
authors.lastname: Hatz
authors.forename: S G
authors.initials: SG
authors.lastname: Wetzel
authors.forename: F
authors.initials: F
authors.lastname: Fluri
authors.forename: P A
authors.initials: PA
authors.lastname: Lyrer
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000209:etiology* / Q000473:pathology*; D008297:Male; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000453:epidemiology* / Q000473:pathology