ABCD2 score

 Q: The ABCD2 score determines patients who are at high risk of ischemic stroke after Transient Ischemic Attack (TIA). Which of the following is not part of the score? (select one)

A) Age

B) Blood pressure

C) Clinical features

D) Days after symptoms

E) Diabetes

Answer: D

The ABCD2 score stands for

• Age
• Blood pressure
• Clinical features
• Duration of symptoms, and 
• Diabetes

It is a prognostic assessment tool. It is intended to identify patients at high risk of ischemic stroke after TIA. This is a very arbitrary calculator (available online) and experts disagree on its accuracy. The 2009 American Heart Association (AHA) and American Stroke Association (ASA) guidelines advise that it is reasonable to hospitalize patients with TIA who present within three days of symptoms and has any of the following criteria: 

•  ABCD2 score of ≥3 
•  ABCD2 score of 0-2 and uncertainty that the diagnostic workup can be completed within two days as an outpatient 
•  ABCD2 score of 0-2 and other evidence that the event was caused by focal ischemia

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References:

1. Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke 2009; 40:2276. 

2.Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 2007; 369:283. 

3. Wardlaw JM, Brazzelli M, Chappell FM, et al. ABCD2 score and secondary stroke prevention: meta-analysis and effect per 1,000 patients triaged. Neurology 2015; 85:373. 

4. Sanders LM, Srikanth VK, Blacker DJ, et al. Performance of the ABCD2 score for stroke risk post TIA: meta-analysis and probability modeling. Neurology 2012; 79:971.

5. Stead LG, Suravaram S, Bellolio MF, et al. An assessment of the incremental value of the ABCD2 score in the emergency department evaluation of transient ischemic attack. Ann Emerg Med 2011; 57:46.