RT Journal Article
SR Electronic
T1 Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 1137
OP 1145
DO 10.1503/cmaj.101668
VO 183
IS 10
A1 Jeffrey J. Perry
A1 Mukul Sharma
A1 Marco L.A. Sivilotti
A1 Jane Sutherland
A1 Cheryl Symington
A1 Andrew Worster
A1 Marcel Émond
A1 Grant Stotts
A1 Albert Y. Jin
A1 Weislaw J. Oczkowski
A1 Demetrios J. Sahlas
A1 Heather E. Murray
A1 Ariane MacKey
A1 Steve Verreault
A1 George A. Wells
A1 Ian G. Stiell
YR 2011
UL http://www.cmaj.ca/content/183/10/1137.abstract
AB Background: The ABCD2 score (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) is used to identify patients having a transient ischemic attack who are at high risk for imminent stroke. However, despite its widespread implementation, the ABCD2 score has not yet been prospectively validated. We assessed the accuracy of the ABCD2 score for predicting stroke at 7 (primary outcome) and 90 days. Methods: This prospective cohort study enrolled adults from eight Canadian emergency departments who had received a diagnosis of transient ischemic attack. Physicians completed data forms with the ABCD2 score before disposition. The outcome criterion, stroke, was established by a treating neurologist or by an Adjudication Committee. We calculated the sensitivity and specificity for predicting stroke 7 and 90 days after visiting the emergency department using the original “high-risk” cutpoint of an ABCD2 score of more than 5, and the American Heart Association recommendation of a score of more than 2. Results: We enrolled 2056 patients (mean age 68.0 yr, 1046 (50.9%) women) who had a rate of stroke of 1.8% at 7 days and 3.2% at 90 days. An ABCD2 score of more than 5 had a sensitivity of 31.6% (95% confidence interval [CI] 19.1–47.5) for stroke at 7 days and 29.2% (95% CI 19.6–41.2) for stroke at 90 days. An ABCD2 score of more than 2 resulted in sensitivity of 94.7% (95% CI 82.7–98.5) for stroke at 7 days with a specificity of 12.5% (95% CI 11.2–14.1). The accuracy of the ABCD2 score as calculated by either the enrolling physician (area under the curve 0.56; 95% CI 0.47–0.65) or the coordinating centre (area under the curve 0.65; 95% CI 0.57–0.73) was poor. Interpretation: This multicentre prospective study involving patients in emergency departments with transient ischemic attack found the ABCD2 score to be inaccurate, at any cut-point, as a predictor of imminent stroke. Furthermore, the ABCD2 score of more than 2 that is recommended by the American Heart Association is nonspecific.See related commentary by Hill and Coutts on page 1127 and at www.cmaj.ca/lookup/doi/10.1503/cmaj.110704.