Abstract 3135: ABCD2 Score Can Triage Transient Ischemic Attack (TIA) Patients for Hospitalization
Introduction: Following TIA, there is an increased risk for ischemic stroke. Admission to the hospital is advocated for observation, rapid performance of diagnostic tests, and potential acute intervention. The American Heart Association (AHA) recommends admission following a TIA for patients with ABCD2 scores greater than 3. We aimed to determine the relationship between ABCD2 scores and acute neurologic deterioration (TIA or stroke) during hospitalization.
Methods: We reviewed consecutive patients admitted to our institution following a TIA between August 1, 2006 and March 31, 2011. TIA was defined as transient focal neurological symptoms that could be attributed to a specific vascular distribution and lasted < 24 hours. We collected data on demographics, clinical symptoms, duration, risk factors, and in-hospital treatments and outcomes.
Results: Of 251 patients (mean age 64 years; 45% male), the median ABCD2 score was 4. The majority had motor symptoms (58.6%) and/or speech/language symptoms (51.4%). Diffusion-weighted imaging was abnormal in 25.9%. The median length of stay was 2.0 days. Nine patients (3.6%) had recurrent TIAs or strokes during their stay (6 TIAs and 3 strokes). All 9 had ABCD2 scores > 3 while no neurologic deterioration occurred in patients with lower scores (5.3% vs. 0%, P = 0.061). Diffusion lesion frequency did not differ between groups. A total of 13 patients (5.2%) required acute revascularization for large vessel stenosis (6 intracranial; 7 extracranial carotid); none were in the group with recurrent events while hospitalized. No patient received intravenous or intra-arterial thrombolysis. ABCD2 score did not discriminate those requiring acute revascularization from those who did not (P = 0.242)
Conclusions: Our findings support the AHA recommendation that TIA patients be considered for hospitalization when ABCD2 scores > 3 based on a 5% risk of in-hospital deterioration. However, interventions to prevent stroke were equally common in those with low or high ABCD2 scores. Outpatient evaluation should be considered for those with scores ≤ 3, provided that vascular imaging is performed urgently and treatment can be expedited.
- © 2012 by American Heart Association, Inc.