The ABCD score showed a non-significant trend for predicting high-risk causes of cerebral ischemia (P for trend=0.11), with patients scoring <4 still having a substantial probability of high risk.
Cohort (n=117)
Does the ABCD score accurately identify low-risk patients among those hospitalized with acute transient ischemic attack?
Patients with an ABCD score <4 still have a substantial probability of having a high-risk cause of cerebral ischemia or radiographic evidence of acute infarction, challenging its utility for identifying minimal-risk TIA patients.
p-value: p=0.11
BACKGROUND AND PURPOSE: A 6-point scoring system (ABCD) was described recently for stratifying risk after transient ischemic attack (TIA). This score incorporates age (A), blood pressure (B), clinical features (C), and duration (D) of TIA. A score or =50% stenosis in a relevant artery, or a cardioembolic source warranting anticoagulation. All others were classified as low risk. Findings on diffusion-weighted MRI (DWI) were also evaluated when performed and patients classified as DWI+ or DWI-. RESULTS: Over 3 years, 117 patients were enrolled. Median time from symptom onset to enrollment was 25.2 hours (interquartile range 19.8 to 30.2). Overall, 26 patients (22%) were classified as high risk, including 2 strokes, 2 deaths, 15 with > or =50% stenosis, and 10 with cardioembolic source. The frequency of high-risk patients increased with ABCD score (0 to 1 13%; 2 8%; 3 17%; 4 27%; 5 26%; 6 30%; P for trend=0.11). ABCD scores in the 2 patients with stroke were 3 and 6. Of those who underwent MRI, 15 of 61 (25%) were DWI+, but this correlated poorly with ABCD score (0 to 1 17%; 2 10%; 3 36%; 4 24%; 5 13%; 6 60%; P for trend=0.24). CONCLUSIONS: Although the ABCD score has some predictive value, patients with a score <4 still have a substantial probability of having a high-risk cause of cerebral ischemia or radiographic evidence of acute infarction despite transient symptoms.
Cucchiara et al. (Fri,) conducted a cohort in Acute Transient Ischemic Attack (n=117). ABCD Score was evaluated on High-risk classification (stroke or death within 90 days, ≥50% stenosis, or cardioembolic source) (p=0.11). The ABCD score showed a non-significant trend for predicting high-risk causes of cerebral ischemia (P for trend=0.11), with patients scoring <4 still having a substantial probability of high risk.