title: A pilot study evaluating the use of ABCD2 score in pre-hospital assessment of patients with suspected transient ischaemic attack: experience and lessons learned.
abstract: BACKGROUND
  Suspected transient ischaemic attack (TIA) is a common presentation to emergency medical services (EMS) in the United Kingdom (UK). Several EMS systems have adopted the ABCD2 score to aid pre-hospital risk stratification and decision-making on patient disposition, such as direct referral to an Emergency Department or specialist TIA clinic. However, the ABCD2 score, developed for hospital use, has not been validated for use in the pre-hospital context of EMS care.
  
  
  METHODS
  We conducted a pilot study to assess eligibility criteria, recruitment rates, protocol compliance, consent and follow-up procedures to inform the development of a definitive study to validate the ABCD2 tool in pre-hospital evaluation of patients with suspected TIA.
  
  
  RESULTS
  From 1st May-1st September 2013, nine patients with an EMS suspected diagnosis of TIA had the TIA diagnosis later confirmed by a specialist from five participating sites. This recruitment rate is comparable to stroke trials in the EMS setting. Bureaucratic obstacles and duplication of approval processes across participating sites took 13 months to resolve before recruitment commenced. Due to the initial difficulty in recruitment, a substantial amendment was approved to modify inclusion criteria, allowing patients with atrial fibrillation and/or taking anticoagulant therapy to participate in the study.
  
  
  CONCLUSIONS
  It is possible to identify, recruit and follow up patients with suspected TIA in the EMS setting. Training large numbers of EMS staff is required as exposure to TIA patients is infrequent. Significant insight was gained into the complexity of NHS research governance mechanisms in the UK. This knowledge will facilitate the planning of a future adequately powered study to validate the ABCD2 tool in a pre-hospital setting.
authors.affiliation: South East Coast Ambulance Service NHS Foundation Trust, Banstead, Surrey SM7 2AS UK ; School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH UK.
authors.forename: Scott
authors.initials: S
authors.lastname: Munro
authors.affiliation: South East Coast Ambulance Service NHS Foundation Trust, Banstead, Surrey SM7 2AS UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Rodbard
authors.affiliation: Brighton and Sussex Medical School, Brighton, BN2 5BE UK.
authors.forename: Khalid
authors.initials: K
authors.lastname: Ali
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Horsfield
authors.affiliation: School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Knibb
authors.affiliation: South East Coast Ambulance Service NHS Foundation Trust, Banstead, Surrey SM7 2AS UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Holah
authors.affiliation: Frimley Health NHS Foundation Trust, Frimley, Surrey GU16 7UJ UK.
authors.forename: Ottilia
authors.initials: O
authors.lastname: Speirs
authors.affiliation: Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, SW17 0RE UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Quinn
keywords: ABCD2 score; Bureaucracy; Emergency medical services; Pilot study; Pre-hospital; Transient ischaemic attack