title: Long-term risk of stroke after transient ischaemic attack: a hospital-based validation of the ABCD² rule.
abstract: BACKGROUND
  The ABCD2 clinical prediction rule is a seven point summation of clinical factors independently predictive of stroke risk. The purpose of this cohort study is to validate the ABCD2 rule in a Bulgarian hospital up to three years after TIA.
  
  
  METHODS
  All consecutive admissions to an emergency department with symptoms of a first TIA were included. Baseline data and clinical examinations including the ABCD2 scores were documented by neurologists. Discrimination and calibration performance was examined using ABCD2 cut-off scores of ≥3, ≥4 and ≥5 points, consistent with the international guidelines. The Hosmer-Lemeshow test was used to examine calibration between the observed and expected outcomes as predicted by ABCD2 score within the logistic regression analysis.
  
  
  RESULTS
  Eighty-nine patients were enrolled to the study with a mean age of 63 years (+/- 12 years). Fifty-nine percent (n = 53) of the study population was male. Seven strokes (7.8%) occurred within the first year and six further strokes within the three-year follow-up period. There was no incident of stroke within the first 90 days after TIA. The rule demonstrated good predictive (OR = 1.58, 95% CI 1.09-2.29) and discriminative performance (AUCROC = 0.72, 95% CI 0.58-0.86), as well as a moderate calibration performance at three years.
  
  
  CONCLUSIONS
  This validation of the ABCD2 rule in a Bulgarian hospital demonstrates that the rule has good predictive and discriminative performance at three years. The ABCD2 is quick to administer and may serve as a useful tool to assist clinicians in the long-term management of individuals with TIA.
authors.affiliation: HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St, Stephens Green, Dublin 2, Republic of Ireland. rosegalvin@rcsi.ie.
authors.forename: Rose
authors.initials: R
authors.lastname: Galvin
authors.forename: Penka A
authors.initials: PA
authors.lastname: Atanassova
authors.forename: Nicola
authors.initials: N
authors.lastname: Motterlini
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
authors.forename: Borislav D
authors.initials: BD
authors.lastname: Dimitrov
mesh_terms: D002138:Calibration; D003710:Demography; D005260:Female; D006761:Hospitals; D006801:Humans; D015994:Incidence; D002546:Ischemic Attack, Transient / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*; D013997:Time Factors