A pilot study evaluating the use of ABCD2 score in pre-hospital assessment of patients with suspected transient ischaemic attack: experience and lessons learned

Abstract

Background: Suspected transient ischaemic attack (TIA) is a common presentation to emergency medical services (EMS) in the United Kingdom (UK). Several EMS systems have adopted the ABCD2 score to aid pre-hospital risk stratification and decision-making on patient disposition, such as direct referral to an Emergency Department or specialist TIA clinic. However, the ABCD2 score, developed for hospital use, has not been validated for use in the pre-hospital context of EMS care. Methods:We conducted a pilot study to assess eligibility criteria, recruitment rates, protocol compliance, consent and follow-up procedures to inform the development of a definitive study to validate the ABCD2 tool in pre-hospital evaluation of patients with suspected TIA.Results: From 1st May-1st September 2013, nine patients with an EMS suspected diagnosis of TIA had the TIA diagnosis later confirmed by a specialist from five participating sites. This recruitment rate is comparable to stroke trials in the EMS setting. Bureaucratic obstacles and duplication of approval processes across participating sites took 13 months to resolve before recruitment commenced. Due to the initial difficulty in recruitment, a substantial amendment was approved to modify inclusion criteria, allowing patients with atrial fibrillation and/or taking anticoagulant therapy to participate in the study. Conclusions:It is possible to identify, recruit and follow up patients with suspected TIA in the EMS setting. Training large numbers of EMS staff is required as exposure to TIA patients is infrequent. Significant insight was gained into the complexity of NHS research governance mechanisms in the UK. This knowledge will facilitate the planning of a future adequately powered study to validate the ABCD2 tool in a pre-hospital setting.

The quality of medication optimization among patients with transient ischemic attack or minor stroke

“…Current AHA/ASA guidelines recommend admission for TIA patients within 72 hours of symptom onset, especially for those in whom the work up cannot be completed in a timely manner in the outpatient setting . However, other evidence indicates that there is no difference in outcomes between ED and inpatient care of TIA patients and promote rapid risk assessments in the ED setting to avoid hospitalization . As efforts to create and utilize these rapid assessments (eg, ABCD2 score) continue, our results emphasize the importance of continuing efforts to provide appropriate secondary prevention implementation in diverse patients and clinical settings.…”

“…However, other evidence indicates that there is no difference in outcomes between ED and inpatient care of TIA patients and promote rapid risk assessments in the ED setting to avoid hospitalization . As efforts to create and utilize these rapid assessments (eg, ABCD2 score) continue, our results emphasize the importance of continuing efforts to provide appropriate secondary prevention implementation in diverse patients and clinical settings. Because it is not typically within the scope of an ED physician's practice to prescribe and make changes to long‐term therapies, implementation of interventions focused on transitions of care and team‐based care are particularly important in this setting.…”