Use of ABCD2 risk scoring system to determine the short-term stroke risk in patients presenting to emergency department with transient ischaemic attack

Objective: To determine the 3-day stroke risk of patients presenting to emergency department with transient ischaemic attack, and to evaluate the predictive value of ABCD² (Age, Blood pressure, Clinical features, Duration of symptoms and Diabetes) score for these patients. Methods: The prospective study was conducted on patients with diagnosis of transient ischaemic attack who were divided into low (0-3 points), medium (4-5 points) and high (6-7 points) risk groups according to their ABCD² scores. The sensitivity of the scoring system on estimation of the risk of stroke in 3 days was evaluated through receiver operating characteristic curve. SPSS 15 was used for data analysis. Results: Of the 64 patients in the study, none of the low-risk group had stroke. Stroke was present in 4 of 33 (12.12%) medium-risk patients, while there were 4 in 18 (22.22%) in the high-risk group. Sensitivity and specificity of each ABCD² score for 3rd day stroke risk was calculated. In the receiver operating curve generated by these calculations, the c statistics was determined as 0.76 (95% CI: 0.64, 0.86; p 0.01) and the most appropriate cut-off score to dichotomise the study group was determined as 4. Conclusions: In transient ischaemic attack patients with an ABCD2 score of four or higher had a markedly increased short-term stroke risk, while those with a lower score were quite safe. It is appropriate to hospitalise patients with a score of four or more and investigate for underlying cause and initiate treatment.