A score based on a patient's age, blood pressure, clinical features, and duration of symptoms (ABCD) can help clinicians predict the risk of stroke in the 7 days after a transient ischemic attack (TIA) and identify patients who may need emergency care.
Researchers studied factors reported as significant for predicting stroke in a study of 209 patients with TIA. Eighteen of the patients had a full-blown stroke within 7 days of their TIA. Based on their analysis of these factors, researchers devised the following scoring system:
Age: 60 years or older = 1 point
Blood pressure on admission: systolic greater than 140 mm Hg and/or diastolic greater than 90 mm Hg = 1 point
Clinical features: unilateral weakness = 2 points; speech disturbance without weakness = 1 point; other = 0 points
Duration of symptoms: 60 minutes or longer = 2 points; 10 to 59 minutes = 1 point; less than 10 minutes = 0 points.
Researchers tested their scoring system in two groups of patients with TIA. In one group of 375 patients with TIA, 19 of the 20 patients who had strokes within 7 days had a score of 5 or 6. The 7-day risks were 31% for those with a score of 6 points, 12% for 5 points, and 1% for 4 points.
In the second group of 206 patients, risks were 24% (6 points), 12% (5 points), and 9% (4 points).
Based on their findings, researchers say that an ABCD score of 6 should be considered an emergency and the patient should be admitted to the hospital for acute care.
A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack, The Lancet, PM Rothwell, et al., July 2, 2005.