title: High ABCD2 Scores and In-Hospital Interventions following Transient Ischemic Attack.
abstract: OBJECTIVE
  Following transient ischemic attack (TIA), there is increased risk for ischemic stroke. The American Heart Association recommends admission of patients with ABCD2 scores ≥3 for observation, rapid performance of diagnostic tests, and potential acute intervention. We aimed to determine if there is a relationship between ABCD2 scores, in-hospital ischemic events, and in-hospital treatments after TIA admission.
  
  
  METHODS
  We reviewed consecutive patients admitted between 2006 and 2011 following a TIA, defined as transient focal neurological symptoms attributed to a specific vascular distribution and lasting <24 h. Three interventions were prespecified: anticoagulation for atrial fibrillation, carotid or intracranial revascularization, and intravenous or intra-arterial reperfusion therapies. We compared rates of in-hospital recurrent TIA or ischemic stroke and the receipt of interventions among patients with low (<3) versus high (≥3) ABCD2 scores.
  
  
  RESULTS
  Of 249 patients, 11 patients (4.4%) had recurrent TIAs or strokes during their stay (8 TIAs, 3 strokes). All 11 had ABCD2 scores ≥3, and no neurological events occurred in patients with lower scores (5.1 vs. 0%; p = 0.37). Twelve patients (4.8%) underwent revascularization for large artery stenosis, 16 (6.4%) were started on anticoagulants, and no patient received intravenous or intra-arterial reperfusion therapy. The ABCD2 score was not associated with anticoagulation (p = 0.59) or revascularization (p = 0.20).
  
  
  CONCLUSIONS
  Higher ABCD2 scores may predict early ischemic events after TIA but do not predict the need for intervention. Outpatient evaluation for those with scores <3 would potentially have delayed revascularization or anticoagulant treatment in nearly one-fifth of 'low-risk' patients.
authors.affiliation: Department of Neurological Sciences, Rush University Medical Center, Chicago, Ill., USA.
authors.forename: Shawna
authors.initials: S
authors.lastname: Cutting
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Regan
authors.forename: Vivien H
authors.initials: VH
authors.lastname: Lee
authors.forename: Shyam
authors.initials: S
authors.lastname: Prabhakaran
keywords: Acute stroke; Transient ischemic attack