title: Age but not ABCD(2) score predicts any level of carotid stenosis in either symptomatic or asymptomatic side in transient ischaemic attack.
abstract: BACKGROUND
  The ABCD(2) score is routinely used in assessment of transient ischaemic attack (TIA) to assess the risk of developing stroke. There remains uncertainty regarding whether the ABCD(2) score could be used to help predict extent of carotid artery stenosis (CAS).
  
  
  OBJECTIVE
  We aimed to (i) collate and analyse all available published literature on this topic and (ii) compare the data from our local population to the existing evidence base.
  
  
  METHODS
  We conducted a retrospective-observational study over a 6-month period using our East of England hospital-based TIA clinic data with a catchment population of ~750,000. We also searched the literature on studies reporting the association between ABCD(2) score and CAS.
  
  
  RESULTS
  We included 341 patients in our observational study. The mean age in our cohort was 72.86 years (SD 10.91) with 52% male participants. ABCD(2) score was not significantly associated with CAS (p = 0.78). Only age > 60 years was significantly associated with ipsilateral (> 50%) and contralateral CAS (> 50% and > 70%) (p < 0.01) after controlling for other confounders. The systematic review identified four studies for inclusion and no significant association between ABCD(2) score and CAS was reported, confirming our findings.
  
  
  CONCLUSIONS
  Our systematic review and observational study confirm that the ABCD(2) score does not predict CAS. However, our observational study has examined a larger number of possible predictors and demonstrates that age appears to be the single best predictor of CAS in patients presenting with a TIA. Selection of urgent carotid ultrasound scan thus should be based on individual patient's age and potential benefit of carotid intervention rather than ABCD(2) score.
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.|Norfolk and Norwich University Hospital, Norfolk, UK.
authors.forename: G S
authors.initials: GS
authors.lastname: Mannu
authors.affiliation: Norfolk and Norwich University Hospital, Norfolk, UK.|Huddersfield Royal Infirmary, West Yorkshire, UK.
authors.forename: M M
authors.initials: MM
authors.lastname: Kyu
authors.affiliation: Norfolk and Norwich University Hospital, Norfolk, UK.|University of East Anglia, Norwich, UK.
authors.forename: J H
authors.initials: JH
authors.lastname: Bettencourt-Silva
authors.affiliation: Norfolk and Norwich University Hospital, Norfolk, UK.|University of East Anglia, Norwich, UK.
authors.forename: Y K
authors.initials: YK
authors.lastname: Loke
authors.affiliation: University of East Anglia, Norwich, UK.
authors.forename: A B
authors.initials: AB
authors.lastname: Clark
authors.affiliation: Norfolk and Norwich University Hospital, Norfolk, UK.|University of East Anglia, Norwich, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Metcalf
authors.affiliation: Norfolk and Norwich University Hospital, Norfolk, UK.|University of East Anglia, Norwich, UK.
authors.forename: J F
authors.initials: JF
authors.lastname: Potter
authors.affiliation: University of Aberdeen, Aberdeen, UK.
authors.forename: P K
authors.initials: PK
authors.lastname: Myint
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012196:Review Literature as Topic; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology