New score predicts risk of stroke in patients with transient ischaemic attack

New score predicts risk of stroke in patients with transient ischaemic attack

Researchers from Oxford in the United Kingdom have developed a simple scoring system to help predict which patients with transient ischaemic attack are most likely to have a stroke soon afterwards. The system, called ABCD, scores patients up to a maximum of 6 points according to their age ( 60 years = 1), blood pressure (systolic > 140 mm Hg or diastolic 90, or both = 1), clinical picture (unilateral weakness = 2, speech disturbance without weakness = 1, other = 0) and duration of symptoms ( 60 minutes = 2, 10-59 = 1, < 10 = 0). When tested in a population based cohort of nearly 400 patients with suspected transient ischaemic attack, the ABCD score was highly predictive of early stroke (P < 0.0001); 19 out of the 20 strokes occurred in the 27% of patients with a score of 5 or more. Overall, the seven day risk of stroke was 0.4% for patients who scored less than 5, 12.1% for patients who scored 5, and 31.4% for patients who scored 6.

This preliminary validation looks promising but there's always room for more. In the meantime the authors hope their simple system will help primary care doctors assess patients for referral more rapidly and reliably, and help hospital specialists triage referrals for emergency investigations and treatment. A score of 6, say the authors, should be treated as a medical emergency.

Lancet 2005 June 21; doi 10.1061/S0140-6736(05)66702-5[CrossRef]