The ABCD2 score yielded an AUC of 0.70 (95% CI 0.62-0.78) for predicting stroke at 7 days post-TIA, leading to only small revisions of baseline stroke risk.
Meta-Analysis (n=16,070)
Yes
Does the ABCD2 score accurately predict early stroke risk in patients following TIA?
The ABCD2 score provides only small revisions to baseline stroke risk after TIA, suggesting limited clinical utility, particularly in low-risk settings or when used by nonspecialists.
Effect estimate: AUC 0.70 (95% CI 0.62-0.78)
OBJECTIVE: To study the accuracy of the ABCD2 score in predicting early stroke risk following TIA and to model post-test probability of stroke for varying cutoff scores and baseline stroke risk. METHODS: Medline, PubMed, Embase, conference proceedings, and manuscript references up to October 2010 were searched for studies reporting ABCD2 score and stroke outcome after TIA. Additional data were requested from authors. Meta-analysis, meta-regression, and post-test probability modeling were undertaken to assess prediction of stroke at 2, 7, and 90 days. RESULTS: Of 44 eligible studies, data were available for 33 (16,070 patients): 26/33 reported stroke at 2 days (533 strokes), 32/33 at 7 days (781 strokes), and 28/33 at 90 days (1,028 strokes) after TIA. Using scores 0-3 ("low risk") and 4-7 ("high risk") for stroke at 7 days, pooled measures were sensitivity 0.89 (0.87-0.91), specificity 0.34 (0.33-0.35), positive predictive value 0.08 (0.07-0.09), negative predictive value 0.98 (0.98-0.98), positive likelihood ratio (PLR) 1.43 (1.33-1.54), negative likelihood ratio (NLR) 0.40 (0.33-0.50), and area under the curve (AUC) 0.70 (0.62-0.78). Results were similar at days 2 and 90. There was moderate heterogeneity while pooling PLR (p 50%), with stroke specialist TIA diagnosis associated with slightly higher PLR. At 5% baseline stroke risk, ABCD2 >3 indicated an absolute increase in 7-day stroke risk of only 2.0% while a score ≤3 indicated a 2.9% decrease in risk. Changes in risk were very small when baseline stroke risk was lower. CONCLUSIONS: The ABCD2 score leads to only small revisions of baseline stroke risk particularly in settings of very low baseline risk and when used by nonspecialists.
Sanders et al. (Fri,) conducted a meta-analysis in Transient Ischemic Attack (TIA) (n=16,070). ABCD2 score was evaluated on Stroke at 7 days (AUC 0.70, 95% CI 0.62-0.78). The ABCD2 score yielded an AUC of 0.70 (95% CI 0.62-0.78) for predicting stroke at 7 days post-TIA, leading to only small revisions of baseline stroke risk.