Predictive Value of A2HD Scoring for Transient Symptoms Associated with Infarction

BACKGROUND Effective early management of cerebral infarction patients with transient ischemic attack (TIA) is undermined by an inability to predict who is at highest risk of stroke. MATERIAL AND METHODS A total of 577 TIA patients with symptoms lasting no more than 1 hour were prospectively investigated and divided into a TIA group and a transient symptoms associated with infarction (TSI) group based on diffusion-weighted magnetic resonance imaging findings after hospital admission. The baseline characteristics, symptoms of TIA, features of disease onset, and findings from clinical examinations were compared between the 2 groups. Factors related to TSI were further analyzed. RESULTS Of 577 TIA patients, 127 patients were in the TSI group and 450 were in the TIA group. Anterior circulation events, hemiplegia, aphasia, multiple seizures, maximal duration, atrial fibrillation, and hypointense plaques were included as risk factors for stroke in a model of multivariate analysis, and results showed that hemiplegia, aphasia, multiple seizures, and atrial fibrillation were independent risk factors for TSI. In the final mode, the area under the curve (AUC) was 0.766 (95% confidence interval: 0.729-0.800). According to the A2HD score and odds ratio, hemiplegia (score 2), aphasia (score 2), multiple seizures (score 2), and atrial fibrillation (score 1) were scored, and any increment in the score increased the risk for cerebral infarction by 1.893-fold (95% confidence interval: 1.643-2.181). CONCLUSIONS Risk of TSI seems to be highly predictable. The A2HD score can be used in clinical practice to identify high-risk cerebral infarction patients with TIA who need emergency diagnosis and treatment.