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Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack.


ABSTRACT:

Background

The ABCD2 score (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) is used to identify patients having a transient ischemic attack who are at high risk for imminent stroke. However, despite its widespread implementation, the ABCD2 score has not yet been prospectively validated. We assessed the accuracy of the ABCD2 score for predicting stroke at 7 (primary outcome) and 90 days.

Methods

This prospective cohort study enrolled adults from eight Canadian emergency departments who had received a diagnosis of transient ischemic attack. Physicians completed data forms with the ABCD2 score before disposition. The outcome criterion, stroke, was established by a treating neurologist or by an Adjudication Committee. We calculated the sensitivity and specificity for predicting stroke 7 and 90 days after visiting the emergency department using the original "high-risk" cutpoint of an ABCD2 score of more than 5, and the American Heart Association recommendation of a score of more than 2.

Results

We enrolled 2056 patients (mean age 68.0 yr, 1046 (50.9%) women) who had a rate of stroke of 1.8% at 7 days and 3.2% at 90 days. An ABCD2 score of more than 5 had a sensitivity of 31.6% (95% confidence interval [CI] 19.1-47.5) for stroke at 7 days and 29.2% (95% CI 19.6-41.2) for stroke at 90 days. An ABCD2 score of more than 2 resulted in sensitivity of 94.7% (95% CI 82.7-98.5) for stroke at 7 days with a specificity of 12.5% (95% CI 11.2-14.1). The accuracy of the ABCD2 score as calculated by either the enrolling physician (area under the curve 0.56; 95% CI 0.47-0.65) or the coordinating centre (area under the curve 0.65; 95% CI 0.57-0.73) was poor.

Interpretation

This multicentre prospective study involving patients in emergency departments with transient ischemic attack found the ABCD2 score to be inaccurate, at any cut-point, as a predictor of imminent stroke. Furthermore, the ABCD2 score of more than 2 that is recommended by the American Heart Association is nonspecific.

SUBMITTER: Perry JJ 

PROVIDER: S-EPMC3134721 | biostudies-literature | 2011 Jul

REPOSITORIES: biostudies-literature

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Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack.

Perry Jeffrey J JJ   Sharma Mukul M   Sivilotti Marco L A ML   Sutherland Jane J   Symington Cheryl C   Worster Andrew A   Émond Marcel M   Stotts Grant G   Jin Albert Y AY   Oczkowski Weislaw J WJ   Sahlas Demetrios J DJ   Murray Heather E HE   MacKey Ariane A   Verreault Steve S   Wells George A GA   Stiell Ian G IG  

CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 20110606 10


<h4>Background</h4>The ABCD2 score (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) is used to identify patients having a transient ischemic attack who are at high risk for imminent stroke. However, despite its widespread implementation, the ABCD2 score has not yet been prospectively validated. We assessed the accuracy of the ABCD2 score for predicting stroke at 7 (primary outcome) and 90 days.<h4>Methods</h4>This prospective cohort study enrolled adults from eight Can  ...[more]

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