Medicine:ABCD² score
| ABCD2 score | |
|---|---|
| Medical diagnostics | |
| Calculator | MDCalc |
The ABCD2 score is a clinical prediction rule used to determine the risk for stroke in the days following a transient ischemic attack (TIA, a condition in which temporary brain dysfunction results from oxygen shortage in the brain).[1][2] Its usefulness was questioned in a 2015 review as it was not found to separate those who are at low from those who are at high risk of future problems.[3] A high score correctly predicted 87% of the people who did have a stroke in the following 7 days but also many people who did not have problems.[3]
The ABCD2 score is based on five parameters (age, blood pressure, clinical features, duration of TIA, and presence of diabetes); scores for each item are added together to produce an overall result ranging between zero and seven.[1] People found to have a high score are often sent to a specialist sooner.[1] Other clinical risk factors, such as atrial fibrillation and anticoagulation treatment, as well as ongoing or recurrent TIA, are also relevant.[1]
The ABCD2 score was proposed in 2007 as a modified version of the ABCD score of 2005 (the ABCD score did not consider the presence of diabetes).[4][5][6] In the largest study based on emergency department testing of the ABCD2 score in an acute setting, the score performed poorly in both high-risk and low-risk patients. The study found the score to be 31.6% sensitive in high-risk patients (score >5) and only 12.5% specific in low-risk patients (score ≤2).[7]
Scoring system
| Age | Blood Pressure | Clinical Features | Duration of TIA |
Diabetes | |
|---|---|---|---|---|---|
| no point | <60 years | normal | no speech disturbance and no unilateral (one-sided) weakness | <10 minutes | no diabetes |
| 1 point | ≥60 years | raised (≥140/90 mmHg) |
speech disturbance present but no unilateral weakness | 10–59 minutes | diabetes present |
| 2 points | – | – | unilateral weakness | ≥60 minutes | – |
- For example, a person aged 60 (1 point) with normal blood pressure (0 point) and without diabetes (0 point) who experienced a TIA lasting 10 minutes (1 point) with a speech disturbance but no weakness on one side of the body (1 point) would score a total of 3 points.
Interpretation
The risk for stroke can be estimated from the ABCD2 score as follows:
- Score 1-3 (low)
- 2 day risk = 1.0%
- 7 day risk = 1.2%
- Score 4-5 (moderate)
- 2 day risk = 4.1%
- 7 day risk = 5.9%
- Score 6–7 (high)
- 2 day risk = 8.1%
- 7 day risk = 11.7%
References
- ↑ 1.0 1.1 1.2 1.3 "Preventing strokes: the assessment and management of people with transient ischaemic attack". N. Z. Med. J. 122 (1293): 3556. April 2009. PMID 19448791. Archived from the original on 2010-06-05. https://web.archive.org/web/20100605020850/http://www.nzma.org.nz/journal/122-1293/3556/content.pdf.
- ↑ "Prognostic value of the ABCD² clinical prediction rule: a systematic review and meta-analysis". Fam Pract 28 (4): 366–76. August 2011. doi:10.1093/fampra/cmr008. PMID 21486940.
- ↑ 3.0 3.1 Wardlaw, JM; Brazzelli, M; Chappell, FM; Miranda, H; Shuler, K; Sandercock, PA; Dennis, MS (28 July 2015). "ABCD2 score and secondary stroke prevention: meta-analysis and effect per 1,000 patients triaged.". Neurology 85 (4): 373–80. doi:10.1212/wnl.0000000000001780. PMID 26136519.
- ↑ "Systematic review and pooled analysis of published and unpublished validations of the ABCD and ABCD2 transient ischemic attack risk scores". Stroke 41 (4): 667–73. 2010. doi:10.1161/STROKEAHA.109.571174. PMID 20185786.
- ↑ "A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack". Lancet 366 (9479): 29–36. 2005. doi:10.1016/S0140-6736(05)66702-5. PMID 15993230.
- ↑ "Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack". Lancet 369 (9558): 283–92. January 2007. doi:10.1016/S0140-6736(07)60150-0. PMID 17258668.
- ↑ "Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack.". Canadian Medical Association Journal 183 (10): 1137–45. 2011. doi:10.1503/cmaj.101668. PMID 21646462.
External links
- ABCD2 score online calculator
- ABCD2 Score for TIA with expert insights
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