Multicenter external validation of the ABCD2 score in triaging TIA patients

Area of Science:

• Neurology
• Clinical Medicine
• Epidemiology

Background:

• Transient ischemic attack (TIA) poses a significant risk of subsequent stroke.
• The ABCD(2) score was developed to stratify TIA patients by early stroke risk.
• External validation of the ABCD(2) score has produced inconsistent results.

Purpose of the Study:

• To prospectively validate the predictive accuracy of the ABCD(2) score in a multicenter case series.
• To assess the ABCD(2) score's ability to triage TIA patients for early stroke risk.

Main Methods:

• Prospective calculation of the ABCD(2) score in consecutive hospitalized TIA patients across three tertiary neurology departments.
• Inclusion of multi-ethnic populations (white and Asian) to assess generalizability.
• Evaluation of stroke risk at 7 days and 90 days post-TIA.

Main Results:

• The study included 148 TIA patients, with 7-day and 90-day stroke risks of 8% and 16%, respectively.
• The ABCD(2) score demonstrated good discrimination for 7-day (c-statistic 0.72) and 90-day (c-statistic 0.75) stroke risk.
• Patients with an ABCD(2) score >2 had a nearly 5-fold increased 90-day risk of stroke (HR 4.65).

Conclusions:

• The ABCD(2) score is externally validated as a useful tool for triaging TIA patients at high risk of early stroke.
• Findings support current guidelines recommending immediate hospitalization for TIA patients with an ABCD(2) score >2.
• The score's utility was confirmed in a multi-ethnic, hospitalized TIA patient cohort.