Published Online
on October 19, 2006

A more recent version of this article appeared on December 1, 2006

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Submitted on June 4, 2006
Revised on July 29, 2006
Accepted on August 11, 2006

Validation of the ABCD Score in Identifying Individuals at High Early Risk of Stroke After a Transient Ischemic Attack. A Hospital-Based Case Series Study

Georgios Tsivgoulis MD^*; Konstantinos Spengos MD; Panagiota Manta MD; Nikolaos Karandreas MD; Thomas Zambelis MD; Nikolaos Zakopoulos MD; and Demetrios Vassilopoulos MD, PhD

From Departments of Neurology (G.T., K.S., P.M., N.K., T.Z., D.V.) and Clinical Therapeutics (N.Z.), University of Athens School of Medicine, Athens, Greece.

^* To whom correspondence should be addressed. E-mail: tsivgoulisgiorg{at}yahoo.gr.

Background and Purpose--A simple score derived in the Oxfordshire Community Stroke Project (ABCD score) was able to identify individuals at high early risk of stroke after a transient ischemic attack (TIA) both in a population-based and a hospital-referred clinic cohort. We aimed to further validate the former score in a cohort of hospitalized TIA patients.

Methods--We retrospectively reviewed the emergency room and hospital records of consecutive patients hospitalized in our neurological department with a definite TIA according to the World Health Organization (WHO) criteria during a 5-year period. The 6-point ABCD score (age [<60 years=0, 60 years=1]; blood pressure [systolic 140 mm Hg and diastolic 90 mm Hg=0, systolic >140 mm Hg and/or diastolic >90 mm Hg=1]; clinical features [unilateral weakness=2, speech disturbance without weakness=1, other symptom=0]; duration of symptoms [<10 minutes=0, 10 to 59 minutes=1, 60 minutes=2]) was used to stratify the 30-day stroke risk.

Results--The 30-day risk of stroke in the present case series (n=226) was 9.7% (95% CI, 5.8% to 13.6%). The ABCD score was highly predictive of 30-day risk of stroke (ABCD=0 to 2: 0%, ABCD=3: 3.5% [95% CI, 0% to 8.2%], ABCD=4: 7.6% [95% CI, 1.2% to 14.0%], ABCD=5: 21.3% [95% CI, 10.4% to 33.0%], ABCD=6: 31.3% [95% CI, 8.6% to 54.0%]; log-rank test=23.09; df=6; P=0.0008; P for linear trend across the ABCD score levels <0.00001). After adjustment for stroke risk factors, history of previous TIA, medication use before the index TIA, and secondary prevention treatment strategies, an ABCD score of 5 to 6 was independently (P<0.001) associated with an 8-fold greater 30-day risk of stroke (hazard ratio, 8.01; 95% CI, 3.21 to 19.98).

Conclusions--Our findings validate the predictive value of the ABCD score in identifying hospitalized TIA patients with a high risk of early stroke and provide further evidence for its potential applicability in clinical practice.

Key words: ABCD score • prognosis • stroke • transient ischemic attack

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