TIA Turned Stroke – Avoid It With ABCD2

On the Shoulders of Giants

Don’t Be the Next M&M
Aspects of the California and ABCD scores to predict short-term stroke risk after transient ischemic attack (TIA) were studied, and a unified ABCD2 score was derived and subsequently validated.  The score has 5 parts.  They are below.  Even better, use MDCalc!

  1. Age >/= 60 years = 1 point

  2. Blood pressure >/= 140/90 mm Hg = 1 point

  3. Clinical features: unilateral weakness = 2 points
    Speech impairment without weakness = 1 point

  4. Duration >/= 60 min = 2 points
    10-59 min = 1 point

  5. Diabetes = 1 point

High risk: score 6-7 = 8.1% 2-day stroke risk
Moderate risk: score 4-5 = 4.1% 2-day stroke risk
Low risk: score 0-3 = 1.0% 2-day stroke risk

Spoon Feed
The ABCD2 score is a fair predictor of stroke risk after TIA.  Most agree that scores 4 and up need hospitalization, but it’s best to avoid using it to decide which patients to send home.

Source/Another Spoonful
Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack.  Lancet. 2007 Jan 27;369(9558):283-92.

For patients who are going home, recommend an aspirin a day (any dose x 3 months), NNT to prevent 1 stroke at 6 weeks = 72.

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