title: Varying uses of the ABCD2 scoring system in primary and secondary care: a qualitative study.
abstract: OBJECTIVE
  To explore the usage of the ABCD2 risk stratification score by general practitioners (GPs) and hospital staff during the referral of patients with suspected transient ischaemic attack (TIA) or minor stroke.
  
  
  METHODS
  Qualitative study using semistructured interviews.
  
  
  METHODS
  Nine general practices and two hospital sites in England (Birmingham and Cambridge).
  
  
  METHODS
  Nine GPs and nine hospital staff (two consultants, four nurses, two ultrasonographers and one administrator).
  
  
  RESULTS
  In both sites, clinicians used a referral proforma based around the ABCD2 scoring system for a range of purposes including self-education, to assist emphasising urgency to the patient, as a referral pathway facilitator and as a diagnostic tool. Negative views of its role included potential medicolegal threats, that it was a barrier to appropriate care, and led to misdiagnoses. Despite having differing uses by different clinicians, the ABCD2 proforma was the central means of interprofessional communication in TIA referrals across both sites.
  
  
  CONCLUSIONS
  Understanding how prediction rules are used in practice is key to determining their impact on processes of care and clinical outcomes. In practice, GPs and their colleagues use the ABCD2 score in subtly different ways and it functions as a 'boundary object' by both accommodating these multiple purposes, yet still successfully aiding communication between them.
authors.affiliation: Department of Public Health and Primary Care,  University of Cambridge, Cambridge,  UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: Edwards
authors.forename: Simon R
authors.initials: SR
authors.lastname: Cohn
authors.forename: Nahal
authors.initials: N
authors.lastname: Mavaddat
authors.forename: Satnam K
authors.initials: SK
authors.lastname: Virdee
authors.forename: Daniel
authors.initials: D
authors.lastname: Lasserson
authors.forename: Siobhan
authors.initials: S
authors.lastname: Milner
authors.forename: Matthew
authors.initials: M
authors.lastname: Giles
authors.forename: Richard
authors.initials: R
authors.lastname: McManus
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant