Rapid identification of high-risk transient ischemic attacks: prospective validation of the ABCD score
Rossella Sciolla1, Fabio Melis,
1Neurology Department, University of Turin, ASO San Luigi, Orbassano, Turin, Italy. rsciolla@tiscali.it
Insights
The ABCD score effectively predicts short-term stroke risk after transient ischemic attack (TIA). Adding computed tomography (CT) scan findings further improved stroke risk prediction in this study.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- Transient ischemic attack (TIA) risk stratification is crucial for timely intervention.
- The ABCD score (Age, Blood Pressure, Clinical features, Duration) is a validated tool for short-term stroke risk.
- Prospective validation and refinement of risk scores are essential.
Purpose of the Study:
- To validate the ABCD score in a prospective cohort of TIA patients in Northern Italy.
- To assess the added predictive value of computed tomography (CT) scan findings to the ABCD score.
Main Methods:
- Prospective enrollment of 274 TIA patients presenting to Emergency Departments within 24 hours.
- Stratification using the 6-point ABCD score and a 7-point ABCDI score (including CT imaging).
- Analysis of stroke occurrence within 7 and 30 days post-TIA.
Main Results:
- The ABCD score significantly predicted stroke risk at 7 and 30 days (p<0.05).
- Stroke occurred in 3.6% within 7 days and 5.5% within 30 days.
- Inclusion of CT findings in the ABCDI score further enhanced stroke risk prediction (p<0.01).
Conclusions:
- The ABCD score demonstrated prognostic value in a prospective Italian TIA cohort.
- CT scan findings can significantly improve the accuracy of stroke risk prediction after TIA.
- The ABCDI score shows promise for refined TIA risk stratification.
Background And Purpose:
A 6-point score, based on age, blood pressure, clinical features, and duration (ABCD), was shown to effectively stratify the short-term risk of stroke after a transient ischemic attack (TIA). Prospective validation in different populations of patients should precede its widespread use. Whether adding computed tomography (CT) scan findings to the score would improve its performance deserves exploring. We aimed to validate the ABCD score in a prospective cohort of patients accessing Emergency Departments within 24 hours of a TIA in an area of northern Italy and to acquire preliminary data on CT-based refinement.
Methods:
During a 6-month period, all TIA patients accessing the Emergency Departments of 13 Piemonte and Valle d'Aosta hospitals were prospectively enrolled and stratified according to the 6-point ABCD score and to a 7-point score (ABCDI, where I=imaging) incorporating CT findings.
Results:
Of 274 patients, stroke occurred in 10 (3.6%) within 7 days and in 15 (5.5%) within 30 days. The ABCD score was predictive of stroke risk at both 7 and 30 days (odds ratio for every point of the score=2.55 at 7 days and 2.62 at 30 days; P for linear trend across the ABCD score levels=0.018 at 7 days and 0.0017 at 30 days). CT scan findings further increased prediction (odds ratio for every point of the score=2.68 at 7 days and 2.89 at 30 days; P for linear trend across the ABCDI score levels=0.0043 at 7 days and 0.0003 at 30 days).
Conclusions:
The ABCD score confirmed its prognostic value in this prospective cohort. CT results could further improve prediction.
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