December 9, 2011
View Full PaperPatients With Transient Ischemic Attack With ABCD 2 2 ≥4
Key Result
Patients with TIA and an ABCD2 score <4 who had criteria for emergency treatment had a 90-day stroke rate of 3.9%, compared to 3.4% in those with an ABCD2 score ≥4 (P<0.0001).
Study Design
Type
Cohort (n=1,679)
Structured PICO
Does an ABCD2 score <4 safely identify TIA patients who can be evaluated non-emergently compared to those with ABCD2 score ≥4?
P
Population
1679 patients with definite or possible transient ischemic attack and complete information on ABCD2 score components from the SOS-TIA prospective cohort
I
Intervention
Evaluation and treatment as soon as possible in a transient ischemic attack clinic (87% within 24 hours of first call)
O
Outcome
Stroke at 90 dayshard clinical
TIA patients with an ABCD2 score <4 but with criteria for emergency treatment have a similar 90-day stroke risk as those with an ABCD2 score ≥4, suggesting all TIA patients should be evaluated without delay.
Main Result
Absolute Event Rate: 3.9% vs 3.4%
p-value: p=<0.0001
Abstract
Background and Purpose— It is unclear whether patients with transient ischemic attack with an ABCD 2 score <4 can be safely evaluated within the following week as recommended by some national guidelines rather than in emergency. Methods— A total of 1679 patients in the SOS-TIA prospective cohort had a definite or possible transient ischemic attack and had complete information on ABCD 2 score components. They were evaluated and treated as soon as possible in a transient ischemic attack clinic with round-the-clock access, 87% of them within 24 hours of the first call to medical attention. Criteria for emergency treatment were internal carotid or intracranial artery stenosis ≥50% or major cardiac source of embolism. Results— Primary end point was stroke at 90 days. The 90-day stroke rate (number of events/number of patients) was 3.4% (24/701) in patients with ABCD 2 score ≥4, 3.9% (7/180) in patients with ABCD 2 score <4 and criteria for emergency treatment, and 0.4% (3/798) in patients with ABCD 2 score <4 and no criteria for emergency treatment ( P for between-group comparison <0.0001). Conclusions— When possible, patients with transient ischemic attack should be evaluated without delay regardless of ABCD 2 score because some with lower scores have treatable causes associated with higher short-term risks of stroke.