Document Detail


Modifications of the ABCD(2) Score Do Not Improve the Risk Stratification of Transient Ischemic Attack Patients.
MedLine Citation:
PMID:  21388829     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Modifications to the age, blood pressure, clinical symptoms, duration of symptoms, and diabetes (ABCD(2)) score, which incorporate history of hypertension and acute hyperglycemia in addition to acute blood pressure (BP) elevation and history of diabetes, have been proposed to increase the predictive value of the score. In addition, the timing of acute BP measurement may be important in the emergency department (ED) setting, given the phenomenon of "ED triage hypertension." METHODS: The standard ABCD(2) score was compared to modified scores incorporating various combinations of acute BP elevation or hyperglycemia, history of hypertension or diabetes, and subsequent versus initial ED BP measurements. The number of patients reclassified into an alternate risk category (low/moderate/high) with different schemes was determined. Predictive value using the composite outcome of stroke, death, or high-risk transient ischemic attack mechanism was assessed using c statistics. RESULTS: Modified ABCD(2) scores resulted in few patients shifting risk categories (between 2% and 10% for six alternate schemes), and did not improve the performance of the ABCD(2) score (c-statistics, 0.61-0.65, compared to 0.63 for the standard score). ED triage hypertension was frequent (mean systolic blood pressure [SBP]/diastolic blood pressure [DBP] decrease of 8/9 mm Hg on subsequent measurement; P < .001), but the use of second BP did not reclassify many patients (10%) nor did it improve score performance (c-statistic, 0.61). CONCLUSIONS: Modifications of the ABCD(2) score changed the risk category for few patients and did not improve the overall predictive value of the score.
Authors:
Jonathan M Raser; Brett L Cucchiara
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-3-8
Journal Detail:
Title:  Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association     Volume:  -     ISSN:  1532-8511     ISO Abbreviation:  -     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-3-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111633     Medline TA:  J Stroke Cerebrovasc Dis     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania.
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