Can ABCD ² score predict the need for in-hospital intervention in patients with transient ischemic attacks?

Abstract

Background

The ABCD ² score is increasingly being used to triage patients with transient ischemic attack (TIA). Whether the score can predict the need for in-hospital intervention (IHI), other than initiation of antiplatelets and statins, is unknown.

Aims

The ability of the ABCD ² score to predict IHI would strengthen the rationale to use it as a decision-making tool. We thus conducted this study to investigate the relationship between the ABCD ² score and IHI.

Methods

We analyzed prospectively collected data from consecutive TIA patients over 12 months. We determined ABCD ² upon admission and collected the results of in-hospital evaluation, treatments initiated during hospitalization, and follow-up status. We defined IHI as arterial revascularization or anticoagulation required during admission. We used chi-square for trend to examine the association between ABCD ² and IHI.

Results

We studied 121 patients. Fourteen (12%) had small infarcts on diffusion magnetic resonance imaging; 38 (31%) had a new risk factor recognized during admission [hyperlipidemia ( n = 9), hypertension (1), diabetes (1), carotid stenosis ≥ 50% (16), other arterial occlusive lesions (7), and potential cardioembolic source (4)]. Their percentages increased with higher ABCD ² scores. However, among 12 patients (10%) with IHI, ABCD ² score categories were equally distributed (10% in 0–3, 9% in 4–5, and 10% in 6–7; p = 0.8). One patient (0.8%) worsened during hospitalization; none had a stroke during follow-up.

Conclusion

Patients with an ABCD ² score ≤ 3 had an equal chance of requiring IHI as those with a score of 4–7. The decision to admit TIA patients based on the ABCD ² score alone is not supported by our experience and requires further study.