The FOUR score can be reliably used in the ED by non-neurology staff. Both FOUR score and GCS performed equally well, but the neurologic detail incorporated in the FOUR score makes it more useful in management and triage of patients.

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Objective To study the incremental value of the ABCD2 score in predicting short term risk of ischemic stroke following thorough ED evaluation of transient ischemic attack (TIA). Methods This was a prospective observational study of consecutive patients presenting to the Emergency Department (ED) with a TIA. Patient underwent a full ED evaluation including CNS and carotid artery imaging, after which ABCD2 scores and risk category were assigned. We evaluated correlations between risk categories and occurrence of subsequent ischemic stroke at 7 and 90 days. Results The cohort consisted of 637 patients, (47% women, mean age 73, SD 13 years). There were 15 strokes within 90 days following the index TIA. At 7-days, the rate of stroke according to ABCD2 category in our cohort was: 1.1% in the low risk group, 0.3% in the intermediate risk group, and 2.7% in the high risk group. At 90-days, the rate of stroke in our ED cohort was: 2.1% in the low risk group, 2.1% in the intermediate risk group, and 3.6% in the high risk group. There was no relationship between ABCD2 score at presentation and subsequent stroke following TIA at 7 or 90 days. Conclusion The ABCD2 score did not add incremental value beyond an ED workup that includes CNS and carotid artery imaging in the ability to risk stratify patients with TIA in our cohort. Practice approaches that include brain and carotid artery imaging do not benefit by the incremental addition of the ABCD2 score. In this population of TIA patients, selected by emergency physicians for a rapid ED-based outpatient protocol that included early carotid imaging and treatment when appropriate, the rate of stroke was independent of ABCD2 stratification.

Background. Zinc mediates several vital physiological, enzymatic and cellular functions. The association between serum zinc and stroke outcome has not been previously evaluated. Methods. This single center retrospective study was conducted on consecutive stroke (n = 158) and TIA (n = 74) patients. We sought to determine whether serum zinc concentrations in patients with acute ischemic strokes were associated with stroke severity and poor functional status at discharge, respectively. Results. Overall, out of the 224 patients analyzed (mean age 67 years), 35.7% patients had low zinc levels (65 mcg/dL). Patients with stroke (n = 152) were more likely to have low zinc levels (OR = 2.62, CI 1.92–3.57, P < .003) compared to patients with TIA (n = 72). For patients with stroke (n = 152), multivariate analysis showed that low serum zinc levels (OR 2.82, CI 1.35–5.91, P = .035) and strokes with admission severe strokes (NIHSS > 8) (OR 2.68, CI 1.1–6.5, P = .03) were independently associated with poor functional status (MRS > 3) at discharge from the hospital. Conclusion. Low serum zinc concentrations are associated with more severe strokes on admission and poor functional status at discharge.