%0 Journal Article
%T The ABCD and ABCD2 Scores and the Risk of Stroke following a TIA: A Narrative Review
%A Archit Bhatt
%A Vishal Jani
%J ISRN Neurology
%D 2011
%R 10.5402/2011/518621
%X The California, ABCD, and ABCD2 risk scores (ABCD system) were developed to help stratify short-term stroke risk in patients with TIA (transient ischemic attack). Beyond this scope, the ABCD system has been extensively used to study other prognostic information such as DWI (diffusion-weighted imaging) abnormalities, large artery stenosis, atrial fibrillation and its diagnostic accuracy in TIA patients, which are independent predictors of subsequent stroke in TIA patients. Our comprehensive paper suggested that all scores have and equivalent prognostic value in predicting short-term risk of stroke; however, the ABCD2 score is being predominantly used at most centers. The majority of studies have shown that more than half of the strokes in the first 90 days, occur in the first 7 days. The majority of patients studied were predominantly classified to have a higher ABCD/ABCD2 > 3 scores and were particularly at a higher short-term risk of stroke or TIA and other vascular events. However, patients with low risk ABCD2 score < 4 may have high-risk prognostic indicators, such as diffusion weighted imaging (DWI) abnormalities, large artery atherosclerosis (LAA), and atrial fibrillation (AF). The prognostic value of these scores improved if used in conjunction with clinical information, vascular imaging data, and brain imaging data. Before more data become available, the diagnostic value of these scores, its applicability in triaging patients, and its use in evaluating long-term prognosis are rather secondary; thus, indicating that the primary significance of these scores is for short-term prognostic purposes. 1. Introduction Annually, approximately 240,000 TIAs are diagnosed in the United States [1]. TIAs admissions represent approximately 0.3% of ED (Emergency Department) visits [2], and about 23% of strokes are preceded by a history of TIA [3]. Recent studies have suggested that early care and rapid ED initiated treatment and diagnostic protocols within 24 hours can reduce post-TIA stroke rates significantly [4¨C6]. The short-term risk of stroke after a TIA is substantially higher than previously thought and significantly higher than the short-term risk of recurrent stroke. After a stroke, the 30-day risk of stroke is estimated to be 1.5% (CI 0.6¨C2.5), [7], whereas the risk of stroke following TIA was 3.1% (95% CI 2.0¨C4.1) after 2 days and 5.2% (3.9¨C6.5) after 7 days [8]. Over recent years, three clinical prediction rules (ABCD, California, and ABCD2) (Table 1) have been developed with a purpose of predicting short-term risk of stroke [9, 10]. Although,
%U http://www.hindawi.com/journals/isrn.neurology/2011/518621/