UMEM Educational Pearls

Category: Neurology

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

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

Posted: 6/17/2009 by Aisha Liferidge, MD
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  • 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.