Department of Emergency Medicine

UMEM Educational Pearls

Category: Neurology

Title: Scales to Assess Acute Risk of Stroke after TIA

Keywords: Stroke, TIA, ABCD, ABCD2 (PubMed Search)

Posted: 6/19/2008 by Aisha Liferidge, MD (Updated: 4/18/2024)
Click here to contact Aisha Liferidge, MD

  • The ABCD and ABCD2 scores are validated scales based on both prospective and retrospective data to assess patients' risk of stroke at 7 and 2 days after a TIA, respectively.  The biggest difference between the two is that the ABCD2 Scale includes diabetes as a factor.
  • ABCD Scale
  • Age:  at least 60 = 1 point
  • BP:  SBP > 140 and/or DBP > 90 = 1 point
  • Clinical features:  unilateral weakness = 2 points; speech disturbance w/o weakness = 1 point;  any other neurologic  finding = 0 points.
  • Duration:  at least 60 min. = 2 points; 10-59 min. = 1 point; < 10 min. = 0 points. 
  • Score:  4 points = 1.1% risk;  5 points = 12.1% risk;  6 points = 31.4% risk.
  • ABCD2 Scale
  • Age:  same as ABCD Scale
  • BP:  same as ABCD Scale
  • Clinical features:  same as ABCD Scale except "any other neurologic finding = 0 points" component is omitted.
  • Duration:  same as ABCD Scale except  "< 10 min. = 0 points" component is omitted.
  • Diabetes:  1 point
  • Score:  4-5 points = 4% risk;  6-7 points = 8% risk;  0-3 points = 1% risk.
  • Question = When considering sending a patient home prior to a thorough and appropriate TIA/stroke work-up, how low of a percent risk is acceptable?

References

  • Lancet 2005; 366: 29-36.
  • Lancet 2007; 369: 283-92.
  • ACEP News, June 2008.

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