A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack - PubMed (original) (raw)
A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack
P M Rothwell et al. Lancet. 2005 Jul.
Abstract
Background: Effective early management of patients with transient ischaemic attacks (TIA) is undermined by an inability to predict who is at highest early risk of stroke.
Methods: We derived a score for 7-day risk of stroke in a population-based cohort of patients (n=209) with a probable or definite TIA (Oxfordshire Community Stroke Project; OCSP), and validated the score in a similar population-based cohort (Oxford Vascular Study; OXVASC, n=190). We assessed likely clinical usefulness to front-line health services by using the score to stratify all patients with suspected TIA referred to OXVASC (n=378, outcome: 7-day risk of stroke) and to a hospital-based weekly TIA clinic (n=210; outcome: risk of stroke before appointment).
Results: A six-point score derived in the OCSP (age [> or =60 years=1], blood pressure [systolic >140 mm Hg and/or diastolic > or =90 mm Hg=1], clinical features [unilateral weakness=2, speech disturbance without weakness=1, other=0], and duration of symptoms in min [> or =60=2, 10-59=1, <10=0]; ABCD) was highly predictive of 7-day risk of stroke in OXVASC patients with probable or definite TIA (p<0.0001), in the OXVASC population-based cohort of all referrals with suspected TIA (p<0.0001), and in the hospital-based weekly TIA clinic-referred cohort (p=0.006). In the OXVASC suspected TIA cohort, 19 of 20 (95%) strokes occurred in 101 (27%) patients with a score of 5 or greater: 7-day risk was 0.4% (95% CI 0-1.1) in 274 (73%) patients with a score less than 5, 12.1% (4.2-20.0) in 66 (18%) with a score of 5, and 31.4% (16.0-46.8) in 35 (9%) with a score of 6. In the hospital-referred clinic cohort, 14 (7.5%) patients had a stroke before their scheduled appointment, all with a score of 4 or greater.
Conclusions: Risk of stroke during the 7 days after TIA seems to be highly predictable. Although further validations and refinements are needed, the ABCD score can be used in routine clinical practice to identify high-risk individuals who need emergency investigation and treatment.
Comment in
- Score to predict early stroke after transient ischaemic attack.
Blacker D. Blacker D. Lancet. 2005 Oct 15-21;366(9494):1353; author reply 1353-4. doi: 10.1016/S0140-6736(05)67556-3. Lancet. 2005. PMID: 16226603 No abstract available. - Score to predict early stroke after transient ischaemic attack.
Epstein E, Makomele E. Epstein E, et al. Lancet. 2005 Oct 15-21;366(9494):1353; author reply 1353-4. doi: 10.1016/S0140-6736(05)67555-1. Lancet. 2005. PMID: 16226604 No abstract available. - A simple risk score predicted 7-day stroke risk after transient ischemic attack.
Hart R. Hart R. ACP J Club. 2006 Jan-Feb;144(1):24. ACP J Club. 2006. PMID: 16388573 No abstract available. - A simple risk score predicted 7 day stroke risk after transient ischaemic attack.
Ireland S. Ireland S. Evid Based Nurs. 2006 Jan;9(1):26. doi: 10.1136/ebn.9.1.26. Evid Based Nurs. 2006. PMID: 16437809 No abstract available. - A simple risk score predicted 7 day stroke risk after transient ischaemic attack.
Hart R. Hart R. Evid Based Med. 2006 Feb;11(1):27. doi: 10.1136/ebm.11.1.27. Evid Based Med. 2006. PMID: 17213069 No abstract available. - As simple as ABCD: identifying patients at high risk of stroke soon after a transient ischemic attack.
Harris DR. Harris DR. Can Fam Physician. 2006 Dec;52(12):1553-5. Can Fam Physician. 2006. PMID: 17279235 Free PMC article. No abstract available.
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