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ABCD2 Score

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41. Does ABCD2 score below 4 allow more time to evaluate patients with a transient ischemic attack? (PubMed)

Does ABCD2 score below 4 allow more time to evaluate patients with a transient ischemic attack? The National Institute for Clinical Excellence (NICE) recommends that patients with a transient ischemic attack and ABCD(2) score > or =4 and those with >2 transient ischemic attacks within 1 week be admitted for urgent complete etiologic evaluation within 24 hours and that those with an ABCD(2) score <4 be evaluated less urgently within 1 week.Using data from 1176 patients with a definite (...) or possible transient ischemic attack or minor stroke included in the SOS-TIA registry (January 2003 to June 2007), we studied the usefulness of the conventional ABCD(2) score cutoff as well as the NICE criteria for urgent admission to a stroke unit defined as presence of symptomatic internal carotid artery stenosis > or =50%, symptomatic intracranial artery stenosis > or =50%, or major cardiac source of embolism.Among 697 patients with an ABCD(2) score <4, 20% required immediate consideration

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2009 EvidenceUpdates

42. Early diffusion weighted MRI as a negative predictor for disabling stroke after ABCD2 score risk categorization in transient ischemic attack patients (PubMed)

Early diffusion weighted MRI as a negative predictor for disabling stroke after ABCD2 score risk categorization in transient ischemic attack patients The prognostic value early diffusion-weighted magnetic resonance imaging (DWMRI) adds in the setting of transient ischemic attack (TIA), after risk stratification by a clinical score, is unclear. The purpose of this study is to evaluate, after ABCD2 score risk categorization in admitted TIA patients, whether negative DWMRI performed within 24 (...) hours of symptom onset improves on the identification of patients at low risk for experiencing a disabling stroke within 90 days.At 15 North Carolina hospitals, we enrolled a prospective nonconsecutive sample of admitted TIA patients. We excluded patients not undergoing a DWMRI within 24 hours of admission and patients for whom a dichotomized (< or = or >3) ABCD2 score could not be calculated. We conducted a medical record review to determine disabling ischemic stroke outcomes within 90 days.Over 35

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2009 EvidenceUpdates

43. Prognostic value of the ABCD2 score beyond short-term follow-up after transient ischemic attack (TIA)--a cohort study. (PubMed)

Prognostic value of the ABCD2 score beyond short-term follow-up after transient ischemic attack (TIA)--a cohort study. Transient ischemic attack (TIA) patients are at a high vascular risk. Recently the ABCD2 score was validated for evaluating short-term stroke risk after TIA. We assessed the value of this score to predict the vascular outcome after TIA during medium- to long-term follow-up.The ABCD2 score of 176 TIA patients consecutively admitted to the Stroke Unit was retrospectively (...) for the combined endpoint of cerebral ischemic events, cardiac ischemic events and death of vascular or unknown cause.Fifty-five patients (32.0%) had an ABCD2 score < or = 3, 80 patients (46.5%) had an ABCD2 score of 4-5 points and 37 patients (21.5%) had an ABCD2 score of 6-7 points. Follow-up data were available in 173 (98.3%) patients. Twenty-two patients (13.8%) experienced an ischemic stroke or TIA; 5 (3.0%) a myocardial infarction or acute coronary syndrome; 10 (5.7%) died of vascular or unknown cause

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2010 BMC Neurology

45. PAW17 Recurrent transient ischaemic attack, capsular warning syndrome, ABCD2 score and early risk of stroke: a population-based study. (PubMed)

PAW17 Recurrent transient ischaemic attack, capsular warning syndrome, ABCD2 score and early risk of stroke: a population-based study.

2010 Neurosurgery and Psychiatry

46. Validation of the ABCD2 Score to Identify the Patients With High Risk of Late Stroke After a Transient Ischemic Attack or Minor Ischemic Stroke. (PubMed)

Validation of the ABCD2 Score to Identify the Patients With High Risk of Late Stroke After a Transient Ischemic Attack or Minor Ischemic Stroke. The ABCD(2) score is able to predict the short-term risk of stroke after a transient ischemic attack/minor stroke. We aimed to explore its predictive value for long-term recurrent stroke.Consecutive patients with a transient ischemic attack/minor stroke, hospitalized during a 2-year period, were followed up to document any further stroke and death (...) stratified by a 7-point ABCD(2) score. Result- A total of 490 patients were followed for an average of 40.5 months (SD, 10.7 months). Further stroke were identified in 76 (15.5%) patients and 62 (12.7%) patients died during follow-up. Multivariate Cox regression analysis showed that an ABCD(2) score >4 was found to be an independent risk factor for further stroke (hazard ratio, 2.27; 95% CI, 1.36 to 3.80) and for death (hazard ratio, 1.68; 95% CI, 0.99 to 2.85).In addition to predicting short-term stroke

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2010 Stroke

47. Diagnostic Usefulness of the ABCD2 Score to Distinguish Transient Ischemic Attack and Minor Ischemic Stroke From Noncerebrovascular Events. The North Dublin TIA Study. (PubMed)

Diagnostic Usefulness of the ABCD2 Score to Distinguish Transient Ischemic Attack and Minor Ischemic Stroke From Noncerebrovascular Events. The North Dublin TIA Study. Transient ischemic attack (TIA) diagnosis is frequently difficult in clinical practice. Noncerebrovascular symptoms are often misclassified as TIA by nonspecialist physicians. Clinical prediction rules such as ABCD(2) improve the identification of patients with TIA at high risk of early stroke. We hypothesized that the ABCD(2 (...) ) score may partly improve risk stratification due to improved discrimination of true TIA and minor ischemic stroke (MIS) from noncerebrovascular events.Consecutive patients with TIA were identified within a prospective population-based cohort study of stroke and TIA. The cohort was expanded by inclusion of patients with MIS and noncerebrovascular events referred to a daily TIA clinic serving the population. Diagnosis was assigned by a trained stroke physician independent of ABCD(2) score.Five hundred

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2009 Stroke

48. Can the ABCD2 Risk Score Predict Positive Diagnostic Testing for Emergency Department Patients Admitted for Transient Ischemic Attack? (PubMed)

Can the ABCD2 Risk Score Predict Positive Diagnostic Testing for Emergency Department Patients Admitted for Transient Ischemic Attack? We sought to determine if the ABCD2 score, typically used for risk stratification, could predict having a positive diagnostic test in patients evaluated acutely for transient ischemic attack.We performed a retrospective cohort study for patients admitted from our emergency department with a new diagnosis of transient ischemic attack confirmed by a neurologist (...) . ABCD2 scores were calculated and patients with a score of > or = 4 were placed in the high-risk cohort. Tests evaluated included electrocardiogram, CT, MRI, MR angiography, carotid ultrasonography, and echocardiography. Specific test findings considered to signify positive diagnostic tests were created a priori.We identified 256 patients with transient ischemic attack for inclusion; 167 (61%) were female, the median age was 60 years (interquartile range, 50 to 72), and 162 (63%) patients had

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2009 Stroke

49. ABCD2 Scores and Prediction of Noncerebrovascular Diagnoses in an Outpatient Population. A Case-Control Study. (PubMed)

ABCD2 Scores and Prediction of Noncerebrovascular Diagnoses in an Outpatient Population. A Case-Control Study. Among patients with transient ischemic attack, the ABCD2 score predicts short-term stroke risk. Use of the ABCD2 score assumes the underlying diagnosis to be transient ischemic attack; however, most transient ischemic attack services assess a variety of diagnoses. We hypothesized that patients with low ABCD2 score predominantly have noncerebrovascular diagnoses.Our transient ischemic (...) attack clinics assess all suspected cerebrovascular events referred. Comprehensive clinical and investigation details are prospectively recorded. We collated data for patients seen between August 1992 and January 2005 inclusive. We calculated ABCD2 scores and compared proportions of noncerebrovascular diagnoses for each ABCD2 grade using chi(2) analysis. We ran similar analyses for atrial fibrillation, vascular lesions on brain imaging, and carotid stenosis. We calculated positive predictive value

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2009 Stroke

50. The California, ABCD, and Unified ABCD2 Risk Scores and the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging in TIA Patients. (PubMed)

The California, ABCD, and Unified ABCD2 Risk Scores and the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging in TIA Patients. Some clinical models, like California ABCD and unified ABCD2 scores, are now available to predict the early risk of stroke after a TIA. Despite the transitivity of symptoms, DWI identified an area of acute brain ischemia in almost half of patients. It would be interesting to know how the presence of DWI abnormalities relates to clinical risk scores (...) to plan other prognostic variables or to recommend the performance of DWI.We prospectively studied 135 consecutive TIA patients visited by the neurologists in our institution. All patients underwent DWI (3.8+/-1.7 days after symptoms onset). Clinical risk scores (California, ABCD, and ABCD2) were calculated prospectively for each patient. The identification of acute ischemic lesions (positive DWI) was related to the presence of clinical features and clinical risk scores.DWI were positive in 67 (49.6

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2009 Stroke

51. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

assessment and investigation, to be seen within 24 hours of onset of symptoms. [2019] [2019] 1.1.6 Do not use scoring systems, such as ABCD2, to assess risk of subsequent stroke or to inform urgency of referral for people who have had a suspected or confirmed TIA. [2019] [2019] Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 (...) transient ischaemic attack Recommendations 1.1.5 to 1.1.7 Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 22 of 38Wh Why the committee made the recommendations y the committee made the recommendations Evidence showed that risk prediction scores (ABCD2 and ABCD3) used in isolation are poor at discriminating low and high risk

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

52. Comparison of prognostic performance of scores to predict risk of stroke in ED patients with transient ischaemic attack. (PubMed)

Comparison of prognostic performance of scores to predict risk of stroke in ED patients with transient ischaemic attack. To compare the performance of three risk scores (ABCD, ABCD2 and California) in identification of short-term stroke risk in patients with emergency department (ED) diagnosis of transient ischaemic attack. In the retrospective cohort study, information collected included features of clinical risk scores, demographic, clinical and outcome data. The outcome of interest was new (...) stroke occurrence at 2, 7 and 30 days. Data underwent receiver operating curve analyses. Of 326 patients, 17 patients experienced a new stroke within 30 days (4.9%, 95% confidence interval: 2.9-8.0%). C-statistic for high-stroke risk was not significantly different between scores at 2, 7 or 30 days. Using cutoffs of defined risk score cutoffs, the negative predictive values for stroke within 30 days were 97.4% (California), 99.1% (ABCD) and 98.9% (ABCD2), respectively. All three risk scores predict

2010 European Journal of Emergency Medicine

53. CRACKCast E101 – Stroke

a patient presenting with TIA? A simple but suboptimal assessment called the ABCD2 score (ie. ABCD squared, for Age, Blood pressure, Clinical features, Duration of symptoms, and Diabetes) was designed to identify patients at high risk of ischemic stroke in the first seven days after TIA. It’s frowned upon because it was designed for the primary care setting and doesn’t do a very good job in predicting who is high or low risk in real life. Check out this 2015 systematic review: Anyway, it seems to be all (...) from a ventricular drain 17) List three potential complications of ischemic stroke Cerebral edema progressing to increased ICP and deterioration (needing ICU care) Hemorrhagic transformation GI bleeding CHF Hospital related complications: DVT, PE, UTI’s, pneumonia Post-stroke seizures Post-stroke delirium and depression 18) What are poor prognostic factors for ICH? What is a short formula for calculating ICH volume? ICH score predicting mortality: Scored 0-6 ICH Score Mortality Rate 0 0% 1 13% 2 26

2017 CandiEM

54. Critical Issues in the Evaluation of Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department

Fothergill, A., Christianson, T.J., Brown, R.D. Jr. et al. Validation and refinement of the ABCD2 score. A population-based analysis. Stroke . 2009 ; 40 : 2669–2673 | | | , x 10 Giles, M.F., Albers, G.W., Amarenco, P. et al. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA. A multicenter study. Neurology . 2011 ; 77 : 1222–1228 | | | , x 11 Johnston, S.C., Rothwell, P.M., Nguyen-Huynh, M.N. et al. Validation and refinement of scores to predict very early stroke risk after (...) transient ischaemic attack. Lancet . 2007 ; 369 : 283–292 | | | | | , x 12 Kiyohara, T., Kamouchi, M., Kumai, Y. et al. ABCD3 and ABCD3-I scores are superior to ABCD2 score in the prediction of short- and long-term risks of stroke after transient ischemic attack. Stroke . 2014 ; 45 : 418–425 | | | , x 13 Nguyen, H., Kerr, D., and Kelly, A.M. Comparison of prognostic performance of scores to predict risk of stroke in ED patients with transient ischaemic attack. Eur J Emerg Med . 2010 ; 17 : 346–348

2016 American College of Emergency Physicians

55. Efficacy and Safety of Ticagrelor in Relation to Aspirin Use Within the Week Before Randomization in the SOCRATES Trial

dual antiplatelet effect during a high-risk period for subsequent stroke. Therefore, we explored the efficacy and safety of ticagrelor versus aspirin in the patients who received any aspirin the week before randomization.A prespecified subgroup analysis in SOCRATES (n=13 199), randomizing patients with acute ischemic stroke (National Institutes of Health Stroke Scale score of ≤5) or transient ischemic attack (ABCD2 score of ≥4) to 90-day treatment with ticagrelor or aspirin. Patients in the prior

2018 EvidenceUpdates

56. Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke. (PubMed)

patients (estimated cumulative rate, 9.5%; 95% CI, 8.5 to 10.5), with 149 of these patients (43.2%) having had a stroke during the second through fifth years. Rates of death from any cause, death from cardiovascular causes, intracranial hemorrhage, and major bleeding were 10.6%, 2.7%, 1.1%, and 1.5%, respectively, at 5 years. In multivariable analyses, ipsilateral large-artery atherosclerosis, cardioembolism, and a baseline ABCD2 score for the risk of stroke (range, 0 to 7, with higher scores

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2018 NEJM

57. The HINTS Exam to Differentiate Central from Peripheral Vertigo

outperformed the initial MRI with diffusion-­‐weighted imaging, which had a sensitivity for stroke of only 88%. Similar diagnostic properties were identified in the 2nd paper ( ) which compared the accuracy of the HINTS exam to the ABCD2 score in 190 patients from the cross-sectional cohort. The ABCD2 score is a clinical prediction rule to predict short-term stroke risk following a transient ischemic attack. While this comparison seems contrived and unfair, the HINTS test performed quite well

2014 Washington University Emergency Medicine Journal Club

58. Stroke risk after transient ischemic attack in a Norwegian prospective cohort. (PubMed)

stroke risk at 1 week, 3 months and 1 year after TIA, and to determine the predictive value of the dichotomized ABCD2 score (0-3 vs 4-7) at each time point. We used data obtained by telephone follow-up and registry data from the Norwegian Stroke Register.Five hundred and seventy-seven patients with TIA were enrolled of which 85% were examined by a stroke specialist within 24 h after symptom onset. The cumulative incidence of stroke within 1 week, 3 months and 1 year of TIA was 0.9% (95% CI, 0.37-2.0 (...) ), 3.3% (95% CI, 2.1-5.1) and 5.4% (95% CI, 3.9-7.6), respectively. The accuracy of the ABCD2 score provided by c-statistics at 7 days, 3 months and 1 year was 0.62 (95% CI, 0.39-0.85), 0.62 (95% CI, 0.51-0.74) and 0.64 (95% CI, 0.54-0.75), respectively.We found a lower stroke risk after TIA than reported in earlier studies. The ABCD2 score did not reliably discriminate between low and high risk patients, suggesting that it may be less useful in populations with a low risk of stroke after TIA.Unique

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2019 BMC Neurology

59. Autonomic Parameter and Stress Profile Predict Secondary Ischemic Events After Transient Ischemic Attack or Minor Stroke. (PubMed)

Autonomic Parameter and Stress Profile Predict Secondary Ischemic Events After Transient Ischemic Attack or Minor Stroke. Background and Purpose- Traditional risk factors for ischemic stroke are body stressors that are related to autonomic autonomic system (ANS) dysfunction. The value of ABCD2 score (age, blood pressure, clinical features, duration of symptoms, diabetes) to predict ischemic stroke after transient ischemic attack is compromised by the inclusion of a limited number of stressors (...) . We aimed to assess whether markers of ANS function and stress could predict the occurrence of secondary ischemic events after transient ischemic attack or minor stroke. Methods- This is a prospective cohort study in which 201 patients were recruited within 48 hours after initial transient ischemic attack or minor stroke and followed for 90 days to assess the development of secondary ischemic events. ABCD2 score, heart rate variability (HRV) parameters as markers of ANS function, and psychological

2019 Stroke

60. Initiation of the ABCD3-I algorithm for expediated evaluation of transient ischemic attack patients in an emergency department. (PubMed)

in comparison to 28 (24%) patients admitted in the post-implementation cohort (p < 0.001) with similar 90-day post-discharge stroke occurrence (2 in pre-implementation versus 1 in post-implementation groups, p > 0.05). The mean ABCD2 scores were 4.5 (1.4) in pre- and 4.1 (1.3) in post-implementation cohorts (p = 0.01). The mean ABCD3-I scores were 4.5 (1.8) in post-implementation cohorts. Total ED LOS was 310 min (201, 420) in pre- and 275 min (222, 342) in post-implementation cohorts (p > 0.05 (...) Initiation of the ABCD3-I algorithm for expediated evaluation of transient ischemic attack patients in an emergency department. The use of ABCD3-I score for Transient ischemic attack (TIA) evaluation has not been widely investigated in the ED. We aim to determine the performance and cost-effectiveness of an ABCD3-I based pathway for expedited evaluation of TIA patients in the ED.We conducted a single-center, pre- and post-intervention study among ED patients with possible TIA. Accrual occurred

2019 American Journal of Emergency Medicine

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