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Can the ABCD2 risk score predict positive diagnostic testing for emergency department patients admitted for transient

Jon W Schrock1, Aaron Victor, Theodore Losey

  • 1Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44109-1998, USA. jschrock@metrohealth.org

Stroke
|July 25, 2009
PubMed

Insights

The ABCD2 score, used for transient ischemic attack risk, did not predict positive diagnostic tests in most evaluations. An elevated score may indicate severe carotid disease but is not recommended for guiding acute TIA diagnostic testing.

Area of Science:

  • Neurology
  • Diagnostic Imaging
  • Clinical Risk Stratification

Background:

  • Transient ischemic attack (TIA) evaluations require accurate risk stratification.
  • The ABCD2 score is a common tool for assessing TIA risk.
  • The utility of the ABCD2 score in predicting positive diagnostic test results is not well-established.

Purpose of the Study:

  • To determine if the ABCD2 score can predict positive diagnostic test results in patients acutely evaluated for TIA.
  • To assess the correlation between elevated ABCD2 scores and findings on various diagnostic tests.

Main Methods:

  • Retrospective cohort study of 256 patients with neurologist-confirmed TIA.
  • ABCD2 scores were calculated; patients with a score >= 4 were classified as high-risk.
  • Evaluated diagnostic tests included ECG, CT, MRI, MR angiography, carotid ultrasonography, and echocardiography.

Main Results:

  • 63% of patients had an elevated ABCD2 score (>= 4).
  • Diagnostic test completion rates varied significantly by modality.
  • An elevated ABCD2 score was significantly associated only with positive carotid duplex testing (P<0.05).

Conclusions:

  • An elevated ABCD2 score may predict severe carotid occlusive disease.
  • The ABCD2 score does not predict positive outcomes on other commonly ordered TIA diagnostic tests.
  • The ABCD2 score is not recommended for guiding diagnostic testing in acute TIA evaluations.
Abstract

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