The cause of stroke recurrence is multifactorial, and the subtypes of index and recurrent strokes are often not identical. Most recurrences remain unexplained by conventional risk factors.

Higher admission EWS correlate with increased risk of CCU/ICU admission, death and longer hospital stays independent of patient age. An improvement in serial EWS within 4 h of presentation to hospital predicts improved clinical outcomes. The EWS is a potential triage tool in the emergency department for acute medical patients.

Background and Purpose-The role of hypercoagulable states in the pathogenesis of ischemic stroke in black subjects is not known, and data on normal reference ranges in black populations are lacking. This study estimated ethnic-specific reference ranges in a community population to determine the prevalence of thrombophilic states in a multiethnic stroke population. Methods-Free protein S, protein C, antithrombin III, activated protein C resistance, IgG anticardiolipin antibodies, and lupus anticoagulant were determined in 130 consecutive ischemic stroke cases Յ65 years of age (50 black Caribbeans, 30 black Africans, 50 whites) and 130 community controls. Results-Black African controls had significantly lower protein S (PϽ0.001) and protein C (Pϭ0.049) and a trend toward lower antithrombin III (Pϭ0.056) levels compared with white controls. Black Caribbean and African controls had higher diluted Russell's viper venom time ratios compared with whites (Pϭ0.001, PϽ0.001). Using ethnic-specific reference ranges, 8 controls (6.3%) and 11 cases (8.5%) had thrombophilia abnormalities (odds ratio [OR] Key Words: stroke Ⅲ thrombosis H ypercoagulable states may account for a small proportion of ischemic stroke, particularly in younger individuals, 1 although recent studies suggest that in white populations, most positive thrombophilia screening tests are likely to be coincidental rather than causal. 1-3 Individuals of African and African-Caribbean descent have a higher incidence of ischemic stroke compared with whites and present with stroke at a younger age. 4 The prevalence of inherited thrombophilic states shows marked interethnic variation, and the role of thrombophilia in the pathogenesis of ischemic stroke in blacks is not known. [5][6][7][8] Although the factor V Leiden mutation is rare in blacks, both protein S and C deficiencies and lupus anticoagulant have been reported to be more common in individuals of African descent presenting with ischemic stroke. 9 However, data on normal reference ranges in the black community are lacking. If reference ranges are different in black individuals, the inappropriate use of ranges See Editorial Comment, page 1826 derived from white populations could lead to overdiagnosis of thrombophilia abnormalities as a cause of stroke in black individuals.The aim of this study was to determine whether there are ethnic differences in values for thrombophilia assays in normal community controls of white, black Caribbean, and black African ethnicity. Normal reference ranges derived from these data were then used to determine whether prothrombotic states are risk factors for stroke in each ethnic group. We studied younger stroke patients (Յ65 years) because the association between prothrombotic states and stroke appears to be more important in younger individuals. 10 tive case series of patients Յ65 years of age presenting to 3 stroke services in adjacent geographical regions in South London with acute ischemic stroke confirmed by brain imaging. Twelve additional cases on anticoagulant therapy ...