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(Stroke. 2009;40:3091.)
© 2009 American Heart Association, Inc.

Original Contributions

Does ABCD² Score Below 4 Allow More Time to Evaluate Patients With a Transient Ischemic Attack?

Pierre Amarenco, MD; Julien Labreuche, BS; Philippa C. Lavallée, MD; Elena Meseguer, MD; Lucie Cabrejo, MD; Tarik Slaoui, MD; Céline Guidoux, MD; Jean-Marc Olivot, MD, PhD; Halim Abboud, MD; Bertrand Lapergue, MD; Isabelle F. Klein, MD, PhD; Mikael Mazighi, MD, PhD Pierre-Jean Touboul, MD

From INSERM U-698 and Paris-Diderot University, Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France.

Correspondence to Pierre Amarenco, MD, Department of Neurology and Stroke Center, Bichat University Hospital, 46 rue Henri Huchard, 75018 Paris, France. E-mail pierre.amarenco{at}bch.aphp.fr

Background and Purpose— The National Institute for Clinical Excellence (NICE) recommends that patients with a transient ischemic attack and ABCD² score 4 and those with >2 transient ischemic attacks within 1 week be admitted for urgent complete etiologic evaluation within 24 hours and that those with an ABCD² score <4 be evaluated less urgently within 1 week.

Methods— Using data from 1176 patients with a definite or possible transient ischemic attack or minor stroke included in the SOS-TIA registry (January 2003 to June 2007), we studied the usefulness of the conventional ABCD² score cutoff as well as the NICE criteria for urgent admission to a stroke unit defined as presence of symptomatic internal carotid artery stenosis 50%, symptomatic intracranial artery stenosis 50%, or major cardiac source of embolism.

Results— Among 697 patients with an ABCD² score <4, 20% required immediate consideration for emergency treatment (eg, symptomatic internal carotid stenosis 50% in 9.1% of patients, symptomatic intracranial stenosis in 5.0%, atrial fibrillation in 5.9%, other major cardiac source of embolism in 2.1%) in comparison to 31.6% of 497 patients with an ABCD² score 4. The sensitivity and specificity of ABCD² score 4 or NICE criteria for discriminating between patients requiring admission or not were <62% with low positive predictive values (<30%) and high negative predictive values (80%).

Conclusions— One in 5 patients with an ABCD² score <4 had high-risk disease requiring urgent treatment decision-making. When triaging on an ABCD² score, we recommend adding systematic carotid ultrasound (or a default angiographic CT scan) and electrocardiography within 24 hours before postponing complete transient ischemic attack evaluation.

Key Words: ABCD score • stroke • transient ischemic attack