Title: ABCD2 Not as Simple as 1,2,3
68yo woman with unilateral weakness lasting 20 minutes. Blood pressure 165/95.
Does the ABCD2 score predict who will go on to have a stroke in the next 7 or 90 days?
Perry JJ et al. Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ. 2011 Jul 12;183(10):1137-45. Epub 2011 Jun 6.
Prospective cohort trial done in eight Canadian emergency departments. N=2056. Mean age 68yrs with 50.9% women.
Application fo the ABCD2 scored by treating ED physician
Stroke at 7d or 90d as determined by treating neurologist or adjudicating committee.
“This multicentre prospective study involving patients in emergency depart- ments 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.”
BEEM Comments (Dr. Chris Carpenter):
- Sensitivity and Specificity
- Likelihood Ratio
- Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules
- TIA Risk Stratification
- Further TIA Risk Stratification
BEEM Bottom Line:
ABCD2 score is not a reliable way to risk stratify patients presenting to the ED with TIAs on who will go on to have a stroke.