ABCD3-I and ABCD2 Scores in a TIA Population with Low Stroke Risk

Ildstad, Fredrik; Ellekjær, Hanne; Wethal, Torgeir; Lydersen, Stian; Fjærtoft, Hild; Indredavik, Bent

doi:10.1155/2021/8845898

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…The short follow-up period and retrospective design may have introduced unmeasurable confounding effects. However, our prevalence of stroke subtypes and the proportions of moderate and high grades of internal carotid stenosis (>50%) were similar to the national surveys conducted in Asia [ 14 , 33 , 40 , 41 , 42 , 43 , 44 ]. This consistency suggests that there was no pre-selection in our cohort.…”

Section: Discussionsupporting

confidence: 86%

ABCD2-I Score Predicts Unplanned Emergency Department Revisits within 72 Hours Due to Recurrent Acute Ischemic Stroke

Lu,

Lin,

Hou

et al. 2024

Diagnostics

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Background: the ABCD2 score is valuable for predicting early stroke recurrence after a transient ischemic attack (TIA), and Doppler ultrasound can aid in expediting stroke triage. The study aimed to investigate whether combining the ABCD2 score with carotid duplex results can enhance the identification of early acute ischemic stroke after TIA. Methods: we employed a retrospective cohort design for this study, enrolling patients diagnosed with TIA who were discharged from the emergency department (ED). The modified ABCD2-I (c50) score, which incorporates a Doppler ultrasound assessment of internal carotid artery stenosis > 50%, was used to evaluate the risk of acute ischemic stroke within 72 h. Patients were categorized into three risk groups: low risk (with ABCD2 and ABCD2-I scores = 0–4), moderate risk (ABCD2 score = 4–5 and ABCD2-I score = 5–7), and high risk (ABCD2 score = 6–7 and ABCD2-I score = 8–9). Results: between 1 January 2014, and 31 December 2019, 1124 patients with new neurological deficits were screened, with 151 TIA patients discharged from the ED and included in the analysis. Cox proportional hazards analysis showed that patients in the high-risk group, as per the ABCD2-I (c50) score, were significantly associated with revisiting the ED within 72 h due to acute ischemic stroke (HR: 3.12, 95% CI: 1.31–7.41, p = 0.0102), while the ABCD2 alone did not show significant association (HR: 1.12, 95% CI: 0.57–2.22, p = 0.7427). Conclusion: ABCD2-I (c50) scores effectively predict early acute ischemic stroke presentations to the ED within 72 h after TIA.

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Section: Discussionsupporting

confidence: 86%

ABCD2-I Score Predicts Unplanned Emergency Department Revisits within 72 Hours Due to Recurrent Acute Ischemic Stroke

Lu,

Lin,

Hou

et al. 2024

Diagnostics

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“…Several scales were developed to estimate risk of stroke after TIA. ABCD2 (age, blood pressure, clinical features, duration of symptoms, and presence of diabetes mellitus) and ABCD3I (age, blood pressure, clinical features, duration of symptoms, presence of diabetes mellitus, dual TIA, and ipsilatheral carotis stenosis) scores are the most commonly used scores that predict 90-day stroke after TIA [2][3][4]. However, markers that are calculated and easily predicted based on laboratory data are still needed.…”

mentioning

confidence: 99%

Predictive role of ABCD2, ABCD3I, C-reactive protein, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammation index in 90-day and long-term stroke after transient ischemic attack

KOCATÜRK,

GÜLTEN

2023

The European Research Journal

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Objectives: Transient ischemic attack (TIA) is a neurological emergency and a precursor of ischemic stroke. ABCD2 and ABCD3I scores predict stroke after TIA, and clinicians use preclinical, clinical, and radiological parameters for calculating these scores. Our study aimed to investigate the efficacy of peripheral blood markers in predicting 90-day and long-term stroke risk after TIA. Methods: This retrospective study was conducted in Kastamonu Training and Research Hospital between January 2015 and November 2022. The demographic data of 99 patients who applied with the diagnosis of TIA and peripheral blood markers at the time of first admission to the hospital were used in the study. These parameters was evaluated in 90-day and long-term (>12 months) stroke after TIAs. Results: Of the 99 patients in our study, 59% (n = 58) were male. The mean age of the patients was 70 ± 13 years. ABCD2 (age, blood pressure, clinical features, duration of symptoms, and presence of diabetes mellitus) and ABCD3I (age, blood pressure, clinical features, duration of symptoms, presence of diabetes mellitus, dual TIA, and ipsilatheral carotis stenosis) scores and C-reactive protein (CRP) were statistically significant in predicting 90-day stroke. ABCD2 and ABCD3I were not effective in predicting long-term stroke. In addition, CRP, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) parameters were statistically significant in long-term stroke. CRP (AUC=793, sensitivity=82%, and specificity=81%) values were higher than ABCD2 (AUC=779, sensitivity=73%, and specificity=76%) and ABCD3I (AUC=755, sensitivity=82%, and specificity=70%) scores in predicting 90-day stroke. Conclusions: Our study showed that ABCD2, ABCD3I, and CRP effectively predict 90-day stroke after TIA. Furthermore, CRP was more effective than ABCD2 and ABCD3I scores in predicting 90-day stroke after TIA. CRP, NLR, PLR, and SII also effectively predicted long-term stroke after TIA.

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Safety and Feasibility of an Emergency Department–to–Outpatient Pathway for Patients With TIA and Nondisabling Stroke

Roy,

Sreekrishnan,

Camargo Faye

et al. 2023

Neur Clin Pract

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Background and ObjectivesEvaluation of transient ischemic attack/nondisabling ischemic strokes (TIA/NDS) in the emergency department (ED) contributes to capacity issues and increasing health care expenditures, especially high-cost duplicative imaging.MethodsAs an institutional quality improvement project, we developed a novel pathway to evaluate patients with TIA/NDS in the ED using a core set of laboratory tests and CT-based neuroimaging. Patients identified as ‘low risk’ through a safety checklist were discharged and scheduled for prompt outpatient tests and stroke clinic follow-up. In this prespecified analysis designed to assess feasibility and safety, we abstracted data from patients consecutively enrolled in the first 6 months.ResultsWe compared data from 106 patients with TIA/NDS enrolled in the new pathway from April through September 2020 (age 67.9 years, 45% female), against 55 unmatched historical controls with TIA encountered from April 2016 through March 2017 (age 68.3 years, 47% female). Both groups had similar median NIHSS scores (pathway and control 0) and ABCD2scores (pathway and control 3). Pathway-enrolled patients had a 44% decrease in mean ED length of stay (pathway 13.7 hours, control 24.4 hours,p< 0.001) and decreased utilization of ED MRI-based imaging (pathway 63%, control 91%,p< 0.001) and duplicative ED CT plus MRI-based brain and/or vascular imaging (pathway 35%, control 53%,p= 0.04). Among pathway-enrolled patients, 89% were evaluated in our stroke clinic within a median of 5 business days; only 5.5% were lost to follow-up. Both groups had similar 90-day rates of ED revisits (pathway 21%, control 18%,p= 0.84) and recurrent TIA/ischemic stroke (pathway 1%, control 2%,p= 1.0). Recurrent ischemic events among pathway-enrolled patients were attributed to errors in following the safety checklist before discharge.DiscussionOur TIA/NDS pathway, implemented during the initial outbreak of COVID-19, seems feasible and safe, with significant positive impact on ED throughput and ED-based high-cost duplicative imaging. The safety checklist and option of virtual telehealth follow-up are novel features. Broader adoption of such pathways has important implications for value-based health care.

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ABCD3-I and ABCD2 Scores in a TIA Population with Low Stroke Risk

Cited by 4 publications

References 26 publications

ABCD2-I Score Predicts Unplanned Emergency Department Revisits within 72 Hours Due to Recurrent Acute Ischemic Stroke

ABCD2-I Score Predicts Unplanned Emergency Department Revisits within 72 Hours Due to Recurrent Acute Ischemic Stroke

Predictive role of ABCD2, ABCD3I, C-reactive protein, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammation index in 90-day and long-term stroke after transient ischemic attack

Safety and Feasibility of an Emergency Department–to–Outpatient Pathway for Patients With TIA and Nondisabling Stroke

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