ABCD² score

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]

ABCD2 score
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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
ABCD2 score
AgeBlood PressureClinical FeaturesDuration
of TIA		Diabetes
no point <60 yearsnormalno speech disturbance and no unilateral (one-sided) weakness<10 minutesno diabetes
1 point ≥60 yearsraised
(≥140/90 mmHg)		speech disturbance present but no unilateral weakness10–59 minutesdiabetes 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. Gommans J, Barber PA, Fink J (April 2009). "Preventing strokes: the assessment and management of people with transient ischaemic attack" (PDF). N. Z. Med. J. 122 (1293): 3556. PMID 19448791. Archived from the original (PDF) on 2010-06-05.
  2. Galvin R, Geraghty C, Motterlini N, Dimitrov BD, Fahey T (August 2011). "Prognostic value of the ABCD² clinical prediction rule: a systematic review and meta-analysis". Fam Pract. 28 (4): 366–76. doi:10.1093/fampra/cmr008. PMID 21486940.
  3. 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. PMC 4520819. PMID 26136519.
  4. Giles MF, Rothwell PM (2010). "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. doi:10.1161/STROKEAHA.109.571174. PMID 20185786.
  5. Rothwell PM, Giles MF, Flossmann E, et al. (2005). "A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack". Lancet. 366 (9479): 29–36. doi:10.1016/S0140-6736(05)66702-5. PMID 15993230. S2CID 20859717.
  6. Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. (January 2007). "Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack". Lancet. 369 (9558): 283–92. doi:10.1016/S0140-6736(07)60150-0. PMID 17258668. S2CID 9510865.
  7. Perry JJ, Sharma M, Sivilotti ML, Sutherland J, Symington C, Worster A, Émond M, Stotts G, Jin AY, Oczkowski WJ, Sahlas DJ, Murray HE, MacKey A, Verreault S, Wells GA, Stiell IG (2011). "Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack". Canadian Medical Association Journal. 183 (10): 1137–45. doi:10.1503/cmaj.101668. PMC 3134721. PMID 21646462.
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