This Article Full Text Full Text (PDF) All Versions of this Article: 40/10/3202    most recent STROKEAHA.109.560045v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Schrock, J. W. Articles by Losey, T. PubMed PubMed Citation Articles by Schrock, J. W. Articles by Losey, T. Pubmed/NCBI databases Medline Plus Health Information Diagnostic Imaging Health Screening Stroke Transient Ischemic Attack Related Collections Electrocardiology CT and MRI Echocardiography Acute Cerebral Infarction Carotid Stenosis Other Stroke Treatment - Medical

(Stroke. 2009;40:3202.)
© 2009 American Heart Association, Inc.

Original Contributions

Can the ABCD² Risk Score Predict Positive Diagnostic Testing for Emergency Department Patients Admitted for Transient Ischemic Attack?

Jon W. Schrock, MD; Aaron Victor, BS Theodore Losey, MD

From the Department of Emergency Medicine (J.W.S.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio; Case Western Reserve University (A.V.), Cleveland, Ohio; and the Department of Emergency Medicine (T.L.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Correspondence to Jon W. Schrock, MD, MetroHealth Medical Center, Department of Emergency Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109-1998. E-mail jschrock{at}metrohealth.org

Background and Purpose— We sought to determine if the ABCD² score, typically used for risk stratification, could predict having a positive diagnostic test in patients evaluated acutely for transient ischemic attack.

Methods— We performed a retrospective cohort study for patients admitted from our emergency department with a new diagnosis of transient ischemic attack confirmed by a neurologist. ABCD² scores were calculated and patients with a score of 4 were placed in the high-risk cohort. Tests evaluated included electrocardiogram, CT, MRI, MR angiography, carotid ultrasonography, and echocardiography. Specific test findings considered to signify positive diagnostic tests were created a priori.

Results— We identified 256 patients with transient ischemic attack for inclusion; 167 (61%) were female, the median age was 60 years (interquartile range, 50 to 72), and 162 (63%) patients had an ABCD² score of 4. Rates of completion of diagnostic testing were electrocardiogram, 270 (100%); CT, 224 (88%); MRI, 89 (35%); MR angiography, 68 (27%); carotid ultrasonography, 125 (49%); and echocardiography, 135 (53%). Univariate analysis found a significant association only with elevated ABCD² score and carotid duplex testing (P<0.05).

Conclusion— An elevated ABCD² score may help predict patients with severe carotid occlusive disease but does not predict positive outcome in other commonly ordered tests for patients being evaluated for transient ischemic attack. An elevated ABCD² score cannot be recommended as a tool to guide diagnostic testing in patients presenting acutely with transient ischemic attack.

Key Words: ABCD² score • carotid stenosis • stroke • transient ischemic attack