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Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack?
Brett L Cucchiara1, Steve R Messe, Robert A Taylor
1Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA. cucchiar@mail.med.upenn.edu
Insights
The ABCD score shows some predictive value for transient ischemic attack (TIA) risk, but a score below 4 does not guarantee a low risk of stroke or acute infarction.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- A novel 6-point ABCD score was recently introduced to stratify risk after transient ischemic attack (TIA).
- The ABCD score considers age, blood pressure, clinical features, and TIA duration.
- A score below 4 was suggested to indicate minimal short-term stroke risk.
Purpose of the Study:
- To independently evaluate the predictive accuracy of the ABCD scoring system in a new patient cohort.
- To assess the correlation between ABCD scores and high-risk outcomes or diffusion-weighted MRI findings.
Main Methods:
- Prospective study of 117 patients diagnosed with TIA by a neurologist.
- High-risk classification included stroke, death within 90 days, significant arterial stenosis, or need for anticoagulation.
- Diffusion-weighted MRI (DWI) was used to identify acute infarction (DWI+).
Main Results:
- 22% of patients (26/117) were classified as high risk.
- The frequency of high-risk patients showed a trend of increasing with higher ABCD scores (P=0.11).
- Diffusion-weighted MRI (DWI+) findings correlated poorly with ABCD scores (P=0.24).
Conclusions:
- The ABCD score possesses some predictive capability for TIA risk stratification.
- Patients with an ABCD score <4 still have a significant likelihood of high-risk causes or radiographic evidence of acute infarction.
- The ABCD score may underestimate risk in certain TIA patients, necessitating further clinical evaluation.
Background And Purpose:
A 6-point scoring system (ABCD) was described recently for stratifying risk after transient ischemic attack (TIA). This score incorporates age (A), blood pressure (B), clinical features (C), and duration (D) of TIA. A score <4 reportedly indicates minimal short-term stroke risk. We evaluated this scoring system in an independent population.
Methods:
This was a prospective study of TIA patients (diagnosed by a neurologist using the classic <24-hour definition) hospitalized <48 hours from symptom onset. The primary outcome assessment consisted of dichotomization of patients into 2 groups. The high-risk group included patients with stroke or death within 90 days, > or =50% stenosis in a relevant artery, or a cardioembolic source warranting anticoagulation. All others were classified as low risk. Findings on diffusion-weighted MRI (DWI) were also evaluated when performed and patients classified as DWI+ or DWI-.
Results:
Over 3 years, 117 patients were enrolled. Median time from symptom onset to enrollment was 25.2 hours (interquartile range 19.8 to 30.2). Overall, 26 patients (22%) were classified as high risk, including 2 strokes, 2 deaths, 15 with > or =50% stenosis, and 10 with cardioembolic source. The frequency of high-risk patients increased with ABCD score (0 to 1 13%; 2 8%; 3 17%; 4 27%; 5 26%; 6 30%; P for trend=0.11). ABCD scores in the 2 patients with stroke were 3 and 6. Of those who underwent MRI, 15 of 61 (25%) were DWI+, but this correlated poorly with ABCD score (0 to 1 17%; 2 10%; 3 36%; 4 24%; 5 13%; 6 60%; P for trend=0.24).
Conclusions:
Although the ABCD score has some predictive value, patients with a score <4 still have a substantial probability of having a high-risk cause of cerebral ischemia or radiographic evidence of acute infarction despite transient symptoms.
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