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(Stroke. 2006;37:2892.)
© 2006 American Heart Association, Inc.

Original Contributions

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 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.

Correspondence to Georgios Tsivgoulis, Iofontos 2, 11634-Athens, Greece. 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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