An Assessment of the Incremental Value of the ABCD2 Score in the Emergency Department Evaluation of Transient Ischemic Attack

Abstract

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.

An assessment of the cost-effectiveness of magnetic resonance, including diffusion-weighted imaging, in patients with transient ischaemic attack and minor stroke: a systematic review, meta-analysis and economic evaluation

“…Eleven were population-based studies including cohorts from the UK (Oxford), Ireland (Dublin), USA (Texas and Minnesota), Canada (Alberta) and northern Portugal. 9 23,127,129,131,135,136,143,149,153,159 and by both in four; 62,158,162,163 in three studies 120,138,155 this information was not reported.…”

“…178 To reduce the impact of any between-study heterogeneity, we considered separately the 10 studies that provided data on stroke risk at both 7 and 90 days. 62,137,139,143,[149][150][151][152]158,163 The study by Asimos and colleagues was published in two reports. 136,143 Even although the same cohort of patients was studied in both publications, data on risk of stroke at 7 days were reported in the 2010 publication, whereas data on risk of stroke at 90 days were reported in the 2009 publication.…”

“…telephone interviews, medical records, letters) in 11 studies, 65,131,[146][147][148]153,154,158,160,162,163 and was not reported in two studies.…”

“…Four studies assessed population-based cohorts, 132,140,144,151 three studies hospital-based cohorts, 142,155,160 nine studies patients from EDs, 87,134,135,143,149,153,158,162,163 and 10 studies patients from specialist stroke or neurology units. 62,[137][138][139]145,146,150,152,164,177 Full-text papers assessed (n = 61)…”

¿Sirve la escala ABCD2 del AIT para predecir y prevenir Ictus?

“…The low risk of stroke development from TIA in our study could be due to the fact that the majority of patients received early treatment with anti-platelets/anticoagulation and vascular risk factor control 14 . In fact, medical literature shows that the lowest risks were seen in emergency department studies and the highest risks were seen in population-based studies without urgent treatment (0.9% vs 11%) at 7 days after admission to the hospital 15 .…”