title: Frequent inaccuracies in ABCD2 scoring in non-stroke specialists' referrals to a daily Rapid Access Stroke Prevention service.
abstract: The 'accuracy' of age, blood pressure, clinical features, duration and diabetes (ABCD(2)) scoring by non-stroke specialists referring patients to a daily Rapid Access Stroke Prevention (RASP) service is unclear, as is the accuracy of ABCD(2) scoring by trainee residents. In this prospective study, referrals were classified as 'confirmed TIAs' if the stroke specialist confirmed a clinical diagnosis of possible, probable or definite TIA, and 'non-TIAs' if patients had a TIA mimic or completed stroke. ABCD(2) scores from referring physicians were compared with scores by experienced stroke specialists and neurology/geriatric medicine residents at a daily RASP clinic; inter-observer agreement was examined. Data from 101 referrals were analysed (mean age=60.0years, 58% male). The median interval between referral and clinic assessment was 1day. Of 101 referrals, 52 (52%) were 'non-TIAs': 45 (86%) of 52 were 'TIA mimics' and 7 (14%) of 52 were completed strokes. There was only 'fair' agreement in total ABCD(2) scoring between referring physicians and stroke specialists (κ=0.37). Agreement was 'excellent' between residents and stroke specialists (κ=0.91). Twenty of 29 patients scored as 'moderate to high risk' (score 4-6) by stroke specialists were scored 'low risk' (score 0-3) by referring physicians. ABCD(2) scoring by referring doctors is frequently inaccurate, with a tendency to underestimate stroke risk. These findings emphasise the importance of urgent specialist assessment of suspected TIA patients, and that ABCD(2) scores by non-stroke specialists cannot be relied upon in isolation to risk-stratify patients. Inter-observer agreement in ABCD(2) scoring was 'excellent' between residents and stroke specialists, indicating short-term training may improve accuracy.
authors.affiliation: Department of Neurology, The Adelaide and Meath Hospital/National Children's Hospital, Trinity College Dublin, Ireland.
authors.forename: David
authors.initials: D
authors.lastname: Bradley
authors.forename: Simon
authors.initials: S
authors.lastname: Cronin
authors.forename: Justin A
authors.initials: JA
authors.lastname: Kinsella
authors.forename: W Oliver
authors.initials: WO
authors.lastname: Tobin
authors.forename: Ciara
authors.initials: C
authors.lastname: Mahon
authors.forename: Margaret
authors.initials: M
authors.lastname: O'Brien
authors.forename: Róisín
authors.initials: R
authors.lastname: Lonergan
authors.forename: Marie Therese
authors.initials: MT
authors.lastname: Cooney
authors.forename: Sean
authors.initials: S
authors.lastname: Kennelly
authors.forename: D Rónán
authors.initials: DR
authors.lastname: Collins
authors.forename: Desmond
authors.initials: D
authors.lastname: O'Neill
authors.forename: Tara
authors.initials: T
authors.lastname: Coughlan
authors.forename: Shane
authors.initials: S
authors.lastname: Smyth
authors.forename: Dominick J H
authors.initials: DJ
authors.lastname: McCabe
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000592:standards*; D012720:Severity of Illness Index; D013038:Specialization; D020521:Stroke / Q000175:diagnosis* / Q000517:prevention & control*
keywords: ABCD(2); Inter-observer agreement; Prevention; Risk stratification; Stroke; TIA