Multicenter external validation of the ABCD2 score in triaging TIA patients

Objectives: A simple clinical score (ABCD 2 score) has been introduced to triage TIA patients with a high early risk of stroke. External validation studies have yielded inconsistent results regarding the predictive ability of the ABCD 2 score. We aimed to prospectively validate the former score in a multicenter case series study. Methods: We prospectively calculated the ABCD 2 score (age [≥60 years: 1 point]; blood pressure [systolic >140 mm Hg or diastolic >90 mm Hg: 1[; clinical features [unilateral weakness: 2, speech disturbance without weakness: 1, other symptom: 0]; duration of symptoms [ Results: The 7-day and 90-day risks of stroke in the present case series (n = 148) were 8% (95% CI 4%–12%) and 16% (95% CI 10%–22%). The ABCD 2 score accurately discriminated between TIA patients with high 7-day (c statistic 0.72, 95% CI 0.57–0.88) and 90-day (c statistic 0.75, 95% CI 0.65–0.86) risks of stroke. The 90-day risk of stroke was 7-fold higher in patients with an ABCD 2 score >3 points (28%, 95% CI 18%–38%) than in patients with an ABCD 2 score ≤3 points (4%, 95% CI 0%–9%). After adjustment for stroke risk factors, race, history of previous TIA, medication use before the index TIA and secondary prevention treatment strategies, an ABCD 2 score of >2 was associated with a nearly 5-fold greater 90-day risk of stroke (hazard ratio 4.65, 95% CI 1.04–20.84, p = 0.045). Conclusion: Our findings externally validate the usefulness of the ABCD 2 score in triaging TIA patients with a high risk of early stroke in a multiethnic sample of hospitalized patients. The present data support current guidelines endorsing the immediate hospitalization of patients with an ABCD 2 score >2.