Simple Score Accurately Predicts Early Stroke After TIA

Should a patient who suffers a transient ischemic attack (TIA) be hospitalized or be scheduled for an urgent clinic appointment? Because risk for stroke is 5% to 10% during the week after TIA, rapid evaluation is warranted for subgroups at high risk. Using data from a population-based cohort of 209 patients with neurologist-diagnosed probable or definite first TIA and thorough follow-up, researchers in the U.K. have derived a simple score that predicts which patients will experience stroke within 7 days.

The 6-point ABCD score consists of:

• Age: 60 = 1 point
• Blood pressure at presentation: systolic >140 mm Hg or diastolic >90 mm Hg = 1 point
• Clinical features: unilateral weakness = 2 points, speech disturbance without weakness = 1 point
• Duration of symptoms: 60 minutes = 2 points, 10–59 minutes = 1 point, <10 minutes = 0 points

In a validation cohort of 190 patients with neurologist-confirmed probable or definite TIA, 7–day risk for stroke was 0%, 2%, 16%, and 36% among patients with scores of <4, 4, 5, and 6, respectively. In another cohort of 206 patients with suspected TIA who were referred to a hospital TIA clinic (median time from referral to appointment, 9 days), 14 patients (all with scores 4) suffered strokes before their appointments.

Although the ABCD score could be refined further, it should be useful immediately for identifying patients with suspected TIA who require emergency treatment or hospitalization. The authors also propose that it be used in public education campaigns about TIA.

Reference:

Rothwell PM et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 2005 Jul 2; 366:29-36.