Validation of the ABCD²-I score to predict stroke risk after transient ischemic attack
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Published on: January 7, 2019
Xia Meng1, Yilong Wang, Liping Liu
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China.
Insights
The ABCD²-I score better predicts 1-year stroke risk in transient ischemic attack (TIA) patients than the ABCD² score. This validated score improves stroke risk stratification for TIA survivors.
Area of Science:
- Neurology
- Stroke Medicine
- Clinical Prediction Models
Background:
- Transient Ischemic Attack (TIA) is a critical warning sign for subsequent stroke.
- Accurate risk stratification is essential for timely intervention in TIA patients.
- Existing scores like ABCD² have limitations in predicting stroke risk.
Purpose of the Study:
- To prospectively validate the ABCD²-I score for predicting 1-year stroke risk in TIA patients.
- To compare the predictive accuracy of the ABCD²-I score against the ABCD² score.
- To assess the performance of both scores using receiver-operating characteristic analysis.
Main Methods:
- Prospective data collection from 410 TIA patients within 7 days of symptom onset.
- Inclusion of diffusion-weighted imaging (DWI) for all participants.
- Comparison of stroke risk prediction using ABCD² and ABCD²-I scores with defined risk strata and AUC analysis.
Main Results:
- 111 (27.07%) patients experienced annual stroke risk.
- Stroke risk increased with higher ABCD² and ABCD²-I scores.
- The ABCD²-I score demonstrated superior predictive value (AUC 0.77) compared to the ABCD² score (AUC 0.59).
Conclusions:
- The ABCD²-I score is a valuable tool for stratifying 1-year stroke risk in TIA patients.
- The ABCD²-I score offers improved discriminatory power over the ABCD² score for stroke risk prediction.
- This validated score enhances clinical decision-making for TIA management.
Objectives:
The primary aim of this study was to prospectively validate the predictive value of the ABCD²-I score and to then compare the predictive accuracy of the ABCD² score and ABCD²-I score for 1-year risk of stroke in admitted patients with transient ischemic attack (TIA) as defined by the World Health Organization (WHO) time-based criteria.
Methods:
Data were collected from patients with transient ischemic attack within 7 days of symptom onset, and all patients underwent diffusion-weighted imaging (DWI). The predictive values of stratified 1-year rates of recurrent stroke were compared using the age, blood pressure, clinical signs, symptom duration, and ABCD² score with defined cutoff values (0-3, low-risk, 4-5, medium-risk, 6-7, high-risk) and ABCD²-I score cutoff values (0-3, low-risk, 4-6, medium-risk, 7-10, high-risk). In addition, to evaluate the performance of the two scores, we calculated the area under the curve by receiver-operating characteristic.
Results:
Four hundred and ten patients with completed DWI and 12-month follow-up with initial TIA were enrolled in this study. Of these, 111 (27.07%) patients had annual stroke risk. The risk of stroke increased with increasing ABCD² score and ABCD²-I score. The ABCD²-I score had the higher predictive value with areas under the curve of 0.77 than the ABCD² score with areas under the curve of 0.59.
Conclusion:
The ABCD²-I score is a useful tool for stratifying the 1-year risk of stroke in TIA patients, and it improves the discriminatory power of the ABCD² score for the prediction of stroke risk.
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