UMEM Educational Pearls

Title: ABCD Rule to Predict Short-term Stroke Risk After TIA

Category: Neurology

Keywords: tia, stroke, abcd rule, clinical prediction rule (PubMed Search)

Posted: 6/17/2009 by Aisha Liferidge, MD
Click here to contact Aisha Liferidge, MD

5 to 10% of TIA victims go on to have a complete stroke within 7 days.

The following validated ABCD clinical prediction rule can be used to risk stratify your next TIA patient in determining who requires an expedited in-patient work-up:

Risk Factor Score

Age > or = 60 1

Blood Pressure (SBP > 140 and/or DBP > or = 90) 1

Clinical Features (choose one)

-- Unilateral weakness 2

-- Speech impairment w/o weakness 1

-- Other 0

Duration of Symptoms (minutes)

-- > 60 2

-- 10 to 59 1

-- < 10 0

Total 0-6

	Seven-day risk of stroke (stroke/no. of patients; %)
Point total	Possible TIA*	Probable or definite TIA
0 or 1	0/28 (0)	0/2 (0)
2	0/74 (0)	0/28 (0)
3	0/82 (0)	0/32 (0)
4	1/90 (1; 95% CI, 0 to 3)	1/46 (2; 95% CI, 0 to 6)
5	8/66 (12; 95% CI, 4 to 20)	8/49 (16; 95% CI, 6 to 27)
6	11/35 (31; 95% CI, 16 to 47)	11/31 (35; 95% CI, 19 to 52)
Total	20/375 (5.3; 95% CI, 3 to 7.5)	20/188 (10.6; 95% CI, 6 to 15)

References

1. Lovett JK, Dennis MS, Sandercock PA, Bamford J, Warlow CP, Rothwell PM. Very early risk of stroke after a first transient ischemic attack. Stroke 2003;34:e138-40.

2. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA 2000;284:2901-6.

3. Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 2005;366:29-36.