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13-09-2009 | Stroke | Article

ABCD2 score aids differential diagnosis

Abstract

Free abstract

MedWire News: The ABCD2 score, used in clinical practice to predict stroke risk following transient ischemic attack (TIA), is also helpful for distinguishing cerebrovascular from noncerebrovascular events in patients with transient neurologic symptoms.

So say the authors of the North Dublin TIA Study, a substudy of the North Dublin Population Stroke Study, a population-based prospective cohort study of frequency and outcomes of stroke and TIA in nearly 300,000 inhabitants of the city of North Dublin.

The substudy, conducted by Peter Kelly (Mater University Hospital, Dublin, Ireland) and team, included 594 consecutive patients referred to a TIA clinic. The final diagnosis, made by a trained stroke physician, was TIA in 292 patients, minor ischemic stroke (MIS) in 45 patients, and noncerebrovascular events in 257 patients.

Kelly’s team calculated ABCD2 scores for each patient, based on five independent predictors of stroke risk, namely, age, blood pressure, clinical features, duration of symptoms, and presence of diabetes.

They found that the mean ABCD2 score differed by diagnosis, at 4.8 for MIS, 3.9 for TIA, and 2.9 for noncerebrovascular events. The ABCD2 score was also able to discriminate between noncerebrovascular and cerebrovascular events, whether the latter was defined as TIA, any vascular event, or MIS (c-statistics 0.68, 0.70, and 0.81, respectively).

The components of the ABCD2 score driving its discriminatory ability were unilateral weakness and speech disturbance, the authors remark.

Writing in the journal Stroke, Kelly et al say that their study suggests that the ABCD2 score may have some diagnostic utility, and also contributes to an improved understanding of the ability of the score to predict early recurrent stroke after TIA.

“We believe that the score may function as a useful aid for diagnosis and triage of patients with transient neurological symptoms, particularly for nonspecialist physicians who may be the first to assess such patients,” they write.

“However, we caution that it should be used in tandem with improved clinician education and not be used as the sole basis for clinical decision-making for patients with focal neurological symptoms of sudden onset.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

By Joanna Lyford