title: Patients with transient ischemic attack with ABCD2 <4 can have similar 90-day stroke risk as patients with transient ischemic attack with ABCD2 ≥4.
abstract: OBJECTIVE
  It is unclear whether patients with transient ischemic attack with an ABCD(2) score <4 can be safely evaluated within the following week as recommended by some national guidelines rather than in emergency.
  
  
  METHODS
  A total of 1679 patients in the SOS-TIA prospective cohort had a definite or possible transient ischemic attack and had complete information on ABCD(2) score components. They were evaluated and treated as soon as possible in a transient ischemic attack clinic with round-the-clock access, 87% of them within 24 hours of the first call to medical attention. Criteria for emergency treatment were internal carotid or intracranial artery stenosis ≥50% or major cardiac source of embolism.
  
  
  RESULTS
  Primary end point was stroke at 90 days. The 90-day stroke rate (number of events/number of patients) was 3.4% (24/701) in patients with ABCD(2) score ≥4, 3.9% (7/180) in patients with ABCD(2) score <4 and criteria for emergency treatment, and 0.4% (3/798) in patients with ABCD(2) score <4 and no criteria for emergency treatment (P for between-group comparison <0.0001).
  
  
  CONCLUSIONS
  When possible, patients with transient ischemic attack should be evaluated without delay regardless of ABCD(2) score because some with lower scores have treatable causes associated with higher short-term risks of stroke.
authors.affiliation: INSERM U-698 and the Department of Neurology and Stroke Center, Paris-Diderot University, Bichat University Hospital, 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
mesh_terms: D000368:Aged; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000628:therapy; D016893:Carotid Stenosis / Q000150:complications / Q000628:therapy; D002536:Cerebral Arteries; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D004632:Emergency Medical Services; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D014218:Triage / Q000379:methods*