Initiation of the ABCD3-I algorithm for expediated evaluation of transient ischemic attack patients in an emergency department

Dahlquist, Robert T.; Young, Joseph M.; Reyner, Karina; Farzad, Ali; Moleno, Richard B.; Gandham, Gautami; Ho, Amy F.; Wang, Hao

doi:10.1016/j.ajem.2019.06.018

Cited by 6 publications

(17 citation statements)

References 25 publications

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“…It has been argued that some higher-risk patients could benefit from hospital admission, where they can have immediate access to early acute treatment (thrombolysis and thrombectomy) in case of recurrent strokes [12]. A recent study on the use of the ABCD3-I score in the emergency department reported significantly decreased hospital admissions and cost with similar 90-day neurological outcomes after the initiation of an ABCD3-I-based pathway for TIA evaluation [20]. This was however a small study with statistical methodological limitations, a small sample size, and a short follow-up.…”

Section: Discussionmentioning

confidence: 99%

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

Ildstad

Ellekjær

Wethal

et al. 2021

Stroke Research and Treatment

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Objectives. We aimed to evaluate the ABCD3-I score and compare it with the ABCD2 score in short- (1 week) and long-term (3 months; 1 year) stroke risk prediction in our post-TIA stroke risk study, MIDNOR TIA. Materials and Methods. We performed a prospective, multicenter study in Central Norway from 2012 to 2015, enrolling 577 patients with TIA. In a subset of patients with complete data for both scores ( n = 305 ), we calculated the AUC statistics of the ABCD3-I score and compared this with the ABCD2 score. A telephone follow-up and registry data were used for assessing stroke occurrence. Results. Within 1 week, 3 months, and 1 year, 1.0% ( n = 3 ), 3.3% ( n = 10 ), and 5.2% ( n = 16 ) experienced a stroke, respectively. The AUCs for the ABCD3-I score were 0.72 (95% CI, 0.54 to 0.89) at 1 week, 0.66 (95% CI, 0.53 to 0.80) at 3 months, and 0.68 (0.95% CI, 0.56 to 0.79) at 1 year. The corresponding AUCs for the ABCD2 score were 0.55 (95% CI, 0.24 to 0.86), 0.55 (95% CI, 0.42 to 0.68), and 0.63 (95% CI, 0.50 to 0.76). Conclusions. The ABCD3-I score had limited value in a short-term prediction of subsequent stroke after TIA and did not reliably discriminate between low- and high-risk patients in a long-term follow-up. The ABCD2 score did not predict subsequent stroke accurately at any time point. Since there is a generally lower stroke risk after TIA during the last years, the benefit of these clinical risk scores and their role in TIA management seems limited. Clinical Trial Registration. This trial is registered with NCT02038725 (retrospectively registered, January 16, 2014).

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Section: Discussionmentioning

confidence: 99%

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

Ildstad

Ellekjær

Wethal

et al. 2021

Stroke Research and Treatment

View full text Add to dashboard Cite

show abstract

“…12 A recent study on the use of ABCD3-I score in the emergency department reported signi cantly decreased hospital admissions and cost with similar 90-day neurological outcomes after the initiation of an ABCD3-I based pathway for TIA evaluation. 20 This was however a small study with statistical methodological limitations, a small sample size and short follow-up. It was also based on an emergency department which was capable of performing MRI DWI quickly.…”

Section: Discussionmentioning

confidence: 92%

ABCD2 and ABCD3-I scores in a TIA population with low stroke risk

Ildstad

Ellekjær

Wethal

et al. 2020

Preprint

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Background Several clinical risk scores have been developed to predict stroke risk after transient ischemic attack (TIA). We aimed to evaluate the ABCD3-I score and compare it with the ABCD2 score in short and long-term stroke risk prediction in our post TIA stroke risk study, MIDNOR TIA. Methods We performed a prospective, multicenter study in Central Norway from October, 2012, to July, 2015, enrolling 577 patients with TIA. In a subset of patients (n=305) we calculated the AUC statistics of the ABCD3-I score and compared this with the ABCD2 score at 1 week, 3 months and 1 year. To assess stroke occurrences, data obtained by telephone follow-up and registry data from the Norwegian Stroke Register was used. Results Three hundred and five patients had complete data for both ABCD3-I and ABCD2 scores. Within 1 week, 3 months and 1 year, 1.0% (n=3), 3.3% (n=10) and 5.2% (n=16) experienced a stroke, respectively. The AUCs for the ABCD3-I score were 0.72 (95% CI, 0.54 to 0.89) at 1 week (compared with ABCD2 score p =0.019), 0.66 (95% CI, 0.53 to 0.80) at 3 months ( p =0.11), and 0.68 (0.95% CI, 0.56 to 0.79) at 1 year ( p =0.39). Conclusions The ABCD3-I score had limited value in short term prediction of subsequent stroke after TIA and did not reliably discriminate between low and high-risk patients in long-term follow-up. The ABCD2 score did not predict subsequent stroke accurately at any time point. Since modern treatment regimens and a decrease in risk factors in the population have contributed to a generally lower stroke risk after TIA during the last years, the benefit of these clinical risk scores and their role in TIA management seems limited.

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“…A total of 71 studies were included (A. Mowla, MD, unpublished data, 2020). 9 , 15 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ...…”

Section: Resultsmentioning

confidence: 99%

“…Out of 101 cohorts, 16 (15.8%) included patients with TIA and mIS. 27 , 29 , 30 , 32 , 50 , 51 , 52 , 53 , 97 TIA was defined based on a tissue-based definition in 7 studies (9.8%) 33 , 52 , 54 , 55 , 56 , 57 (and A. Mowla, MD, unpublished data, 2020). The Table includes the summary of baseline characteristics and vascular risk factors.…”

Section: Resultsmentioning

confidence: 99%

“…In 15 cohorts (5636 patients; mean [SD] age, 65.7 [3.9] years; 2291 of 4513 [50.8%] men) acute care was delivered in TIA clinics (A. Mowla, MD, unpublished data, 2020). 9 , 29 , 30 , 31 , 32 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 Among the inpatients (33 cohorts; 130 139 patients; mean [SD] age, 78.3 [4.0] years; 49 458 of 128 745 [38.4%] men), 21 cohorts (125 719 patients) received care in medical-surgical units (A. Mowla, MD, unpublished data, 2020), 9 , 15 , 27 , 32 , 38 , 39 , 40 , 41 , 51 , 52 , 53 , 55 , 58 , 59 , 64 , 65 , 79 , 81 , 83 , 84 5 cohorts (2487 patients) in stroke units, 49 , 63 , 79 , 80 , 92 and 7 cohorts (1933 patients) in observation units. 48 , 65 , 66 , 82 , 83 , 84 , 95 In 16 cohorts (3605 patients; mean [SD] age, 68.9 [3.9] years; 1596 of 3046 [52.4%] men), the acute care was offered at the ED (A. Mowla, MD, unpublished data, 2020).…”

Section: Resultsmentioning

confidence: 99%

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