Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack
- PMID: 17258668
- DOI: 10.1016/S0140-6736(07)60150-0
Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack
Abstract
Background: We aimed to validate two similar existing prognostic scores for early risk of stroke after transient ischaemic attack (TIA) and to derive and validate a unified score optimised for prediction of 2-day stroke risk to inform emergency management.
Methods: The California and ABCD scores were validated in four independent groups of patients (n=2893) diagnosed with TIA in emergency departments and clinics in defined populations in the USA and UK. Prognostic value was quantified with c statistics. The two groups used to derive the original scores (n=1916) were used to derive a new unified score based on logistic regression.
Findings: The two existing scores predicted the risk of stroke similarly in each of the four validation cohorts, for stroke risks at 2 days, 7 days, and 90 days (c statistics 0.60-0.81). In both derivation groups, c statistics were improved for a unified score based on five factors (age >or=60 years [1 point]; blood pressure >or=140/90 mm Hg [1]; clinical features: unilateral weakness [2], speech impairment without weakness [1]; duration >or=60 min [2] or 10-59 min [1]; and diabetes [1]). This score, ABCD(2), validated well (c statistics 0.62-0.83); overall, 1012 (21%) of patients were classified as high risk (score 6-7, 8.1% 2-day risk), 2169 (45%) as moderate risk (score 4-5, 4.1%), and 1628 (34%) as low risk (score 0-3, 1.0%).
Implications: Existing prognostic scores for stroke risk after TIA validate well on multiple independent cohorts, but the unified ABCD(2) score is likely to be most predictive. Patients at high risk need immediate evaluation to optimise stroke prevention.
Comment in
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Stroke after transient ischaemic attack: dealing in futures.Lancet. 2007 Jan 27;369(9558):251-2. doi: 10.1016/S0140-6736(07)60121-4. Lancet. 2007. PMID: 17258647 No abstract available.
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Potential applicability of ABCD score in triaging TIA patients.Lancet. 2007 Mar 31;369(9567):1082. doi: 10.1016/S0140-6736(07)60525-X. Lancet. 2007. PMID: 17398306 No abstract available.
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The ABCD, California, and unified ABCD2 risk scores predicted stroke within 2, 7, and 90 days after TIA.ACP J Club. 2007 May-Jun;146(3):79. ACP J Club. 2007. PMID: 17474688 No abstract available.
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The ABCD, California, and unified ABCD2 risk scores predicted stroke within 2, 7, and 90 days after TIA.Evid Based Med. 2007 Jun;12(3):88. doi: 10.1136/ebm.12.3.88. Evid Based Med. 2007. PMID: 17537896 No abstract available.
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