Value of ABCD2 in Predicting Early Ischemic Stroke in Patients Diagnosed with Transient Ischemic Attack
As a significant number of patients diagnosed with transient ischemic attack (TIA) at emergency department are at risk to develop TIA or cerebral vascular accident (CVA), several attempts have been made to figure out a predictive method to detect those at higher risk of such attacks. We aimed to evaluate the role of ABCD2 scoring which includes age, blood pressure, clinical symptoms, diabetes mellitus, and duration of symptoms in predicting short term outcome of the patients presenting with TIA. One hundred consecutive patients visited between 2009 and 2010 in Hazrat Rasoul Akram Hospital and diagnosed with TIA were enrolled and their ABCD2 scores were registered. The incidence of death, CVA, or TIA during the first week after the attack was recorded. Eleven patients suffered new TIA/CVA after 1 week. Sensitivity and specificity of ABCD2 score for predicting CVA/TIA at cut-off point of 4 were 72.7% and 52.8%, respectively. At the same cut-off point for ABCD2, positive and negative predictive values were 16% and 94 %, respectively. Our results show that although patients with ABCD2 score greater than 4 were more likely to develop recurrent TIA/CVA in short term, those with lesser score still harbour a considerable risk for TIA/CVA. Though ABCD2 as an easily applicable tool is very helpful in management of TIA patients at emergency department, but it should not be the only measure to rely on in our decision making.
Menken M, Munsat TL, Toole JF. The global burden of disease study: implications for neurology. Arch Neurol 2000;57(3):418–20.
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367(9524):1747–57.
Hackam DG, Kapral MK, Wang JT, Fang J, Hachinski V. Most stroke patients do not get a warning: a populationbased cohort study. Neurology 2009;73:1074-6.
Johnston SC, Gress DR, Browner WS, Sidney S. Shortterm prognosis after emergency department diagnosis of TIA. JAMA 2000;284(22):2901-6.
Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007 369:283-92.
Stead LG, Suravaram S, Bellolio MF, Enduri S, Rabinstein A, Gilmore RM, Bhagra A, Manivannan V, Decker WW. An assessment of the incremental value of the ABCD2 score in the emergency department evaluation of transient ischemic attack. Ann Emerg Med 2011;57(1):46-51.
Asimos AW, Johnson AM, Rosamond WD, Price MF, Rose KM, Catellier D, Murphy CV, Singh S, Tegeler CH, Felix A. A multicenter evaluation of the ABCD2 score's accuracy for predicting early ischemic stroke in admitted patients with transient ischemic attack. Ann Emerg Med 2010;55(2):201-10.e5.
Perry JJ, Sharma M, Sivilotti ML, Sutherland J, Symington C, Worster A, Émond M, Stotts G, Jin AY, Oczkowski WJ, Sahlas DJ, Murray HE, MacKey A, Verreault S, Wells GA, Stiell IG. Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ 2011;183(10):1137-45.
Chandratheva A, Geraghty OC, Luengo-Fernandez R, Rothwell PM; Oxford Vascular Study. ABCD2 score predicts severity rather than risk of early recurrent events after transient ischemic attack. Stroke 2010;41(5):851-6.
Sanders LM, Srikanth VK, Psihogios H, Wong KK, Ramsay D, Phan TG. Clinical predictive value of the ABCD2 score for early risk of stroke in patients who have had transient ischaemic attack and who present to an Australian tertiary hospital. Med J Aust 2011;194(3):135-8.
Cancelli I, Janes F, Gigli GL, Perelli A, Zanchettin B, Canal G, D'Anna L, Russo V, Barbone F, Valente M. Incidence of Transient Ischemic Attack and Early StrokeRisk: Validation of the ABCD2 Score in an Italian Population-Based Study. Stroke 2011;42(10):2751-7.
Yang J, Fu JH, Chen XY, Chen YK, Leung TW, Mok V, Soo Y, Wong KS. Validation of the ABCD2 score to identify the patients with high risk of late stroke after a transient ischemic attack or minor ischemic stroke. Stroke 2010;41(6):1298-300.
Holzer K, Feurer R, Sadikovic S, Esposito L, Bockelbrink A, Sander D, Hemmer B, Poppert H. Prognostic value of the ABCD2 score beyond short-term follow-up after transient ischemic attack (TIA)--a cohort study. BMC Neurol 2010;10:50.
Sheehan OC, Kyne L, Kelly LA, Hannon N, Marnane M, Merwick A, McCormack PM, Duggan J, Moore A, Moroney J, Daly L, Harris D, Horgan G, Williams EB, Kelly PJ. Population-based study of ABCD2 score, carotid stenosis, and atrial fibrillation for early stroke prediction after transient ischemic attack: the North Dublin TIA study. Stroke 2010;41(5):844-50.
Cucchiara BL, Messe SR, Sansing L, MacKenzie L, Taylor RA, Pacelli J, Shah Q, Pollak ES, Kasner SE. D-dimer, magnetic resonance imaging diffusion-weighted imaging, and ABCD2 score for transient ischemic attack risk stratification. J Stroke Cerebrovasc Dis 2009;18(5):367-73.
Giles MF, Albers GW, Amarenco P, Arsava MM, Asimos A, Ay H, Calvet D, Coutts S, Cucchiara BL, Demchuk AM, Johnston SC, Kelly PJ, Kim AS, Labreuche J, Lavallee PC, Mas JL, Merwick A, Olivot JM, Purroy F, Rosamond WD, Sciolla R, Rothwell PM. Addition of braininfarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients. Stroke 2010;41(9):1907-13.
Fothergill A, Christianson TJ, Brown RD Jr, Rabinstein AA. Validation and refinement of the ABCD2 score: a population-based analysis. Stroke 2009;40(8):2669-73.
Asimos AW, Rosamond WD, Johnson AM, Price MF, Rose KM, Murphy CV, Tegeler CH, Felix A. Early diffusion weighted MRI as a negative predictor for disabling stroke after ABCD2 score risk categorization in transient ischemic attack patients. Stroke 2009;40(10):3252-7.
Giles MF, Rothwell PM. Systematic review and pooled analysis of published and unpublished validations of the ABCD and ABCD2 transient ischemic attack risk scores. Stroke 2010;41(4):667-73.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.