Can ABCD score predict the need for in-hospital intervention in patients with transient ischemic attacks?

Int J Emerg Med. 2010 May 18;3(2):75-80. doi: 10.1007/s12245-010-0176-x.


Background: The ABCD(2) score is increasingly being used to triage patients with transient ischemic attack (TIA). Whether the score can predict the need for in-hospital intervention (IHI), other than initiation of antiplatelets and statins, is unknown.

Aims: The ability of the ABCD(2) score to predict IHI would strengthen the rationale to use it as a decision-making tool. We thus conducted this study to investigate the relationship between the ABCD(2) score and IHI.

Methods: We analyzed prospectively collected data from consecutive TIA patients over 12 months. We determined ABCD(2) upon admission and collected the results of in-hospital evaluation, treatments initiated during hospitalization, and follow-up status. We defined IHI as arterial revascularization or anticoagulation required during admission. We used chi-square for trend to examine the association between ABCD(2) and IHI.

Results: We studied 121 patients. Fourteen (12%) had small infarcts on diffusion magnetic resonance imaging; 38 (31%) had a new risk factor recognized during admission [hyperlipidemia (n = 9), hypertension (1), diabetes (1), carotid stenosis >/= 50% (16), other arterial occlusive lesions (7), and potential cardioembolic source (4)]. Their percentages increased with higher ABCD(2) scores. However, among 12 patients (10%) with IHI, ABCD(2) score categories were equally distributed (10% in 0-3, 9% in 4-5, and 10% in 6-7; p = 0.8). One patient (0.8%) worsened during hospitalization; none had a stroke during follow-up.

Conclusion: Patients with an ABCD(2) score </= 3 had an equal chance of requiring IHI as those with a score of 4-7. The decision to admit TIA patients based on the ABCD(2) score alone is not supported by our experience and requires further study.

Keywords: Prognosis; Stroke risk; Transient ischemic attack.