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ABCD2 Score

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41. 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

42. Efficacy and Safety of Ticagrelor in Relation to Aspirin Use Within the Week Before Randomization in the SOCRATES Trial Full Text available with Trip Pro

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

43. Five-Year Risk of Stroke after TIA or Minor Ischemic Stroke. Full Text available with Trip Pro

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

2018 NEJM

44. Is Transient Ischemic Attack a Medical Emergency? OHTAC Recommendation

, where patients can be evaluated and treated urgently, results in lower rates of stroke and disability than conventional treatment. About half of strokes following TIA occur within the first 48 hours; therefore, patients with TIA should be evaluated as early as possible within 24 hours of first call to medical attention. Patients at high risk of stroke may require admission to a stroke unit for further evaluation and appropriate treatment. This review showed that patients with an ABCD2 score of 4 (...) or higher have significantly higher rates of stroke or recurrent TIA if they receive standard treatment and are discharged from an ED, compared to patients who are hospitalized. This may indicate that higher-risk patients need more comprehensive, intensive investigation and management than lower-risk patients. At the same time, this analysis identified limitations to the use of ABCD2 risk scores in assessing which patients are at higher risk of stroke. ABCD2 risk scores do not reflect the absence

2015 Health Technology Assessment (HTA) Database.

45. Critical Issues in the Evaluation of Adult Patients With Suspected Transient Ischemic Attack in the Emergency Department Full Text available with Trip Pro

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

46. 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

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

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

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

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

49. High-resolution diffusion-weighted imaging identifies ischemic lesions in a majority of transient ischemic attack patients. Full Text available with Trip Pro

presented with DWI lesions. These patients had higher National Institute of Health Stroke Scale and ABCD2 scores and presented more frequently with vessel occlusion and perfusion deficits, but had similar functional outcome at 3 months. Taken together, high-resolution DWI provides evidence of ischemic brain injury in the majority of TIA patients. ANN NEUROL 2019;86:452-457.© 2019 The Authors. Annals of Neurology published by Wiley Periodicals, Inc. on behalf of American Neurological Association.

2019 Annals of Neurology

50. Stroke risk after transient ischemic attack in a Norwegian prospective cohort. Full Text available with Trip Pro

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

2019 BMC Neurology

51. Transient Ischaemic Attack Rarely Precedes Stroke in a Cohort with Low Proportions of Large Artery Atherosclerosis: A Population-Based Study Full Text available with Trip Pro

strokes, 16% (95% confidence interval [CI] 12-22) were from LAA. Of 258 ischaemic stroke patients, only 11 (4%; 95% CI 2-7) reported symptoms in the preceding 90 days consistent with TIA. Nine (82%) sought medical attention. The median ABCD2 score in this group was 4.5 (IQR: 3-7), and the median time of event prior to stroke was 20 days (IQR: 4-32).In our population-based cohort, rates of TIA preceding ischaemic stroke were much lower than previously reported, probably reflective of effective

2018 Cerebrovascular Diseases Extra

52. Antiplatelet vs R-tPA for Acute Mild Ischemic Stroke

with alteplase for acute ischemic stroke within 4.5 hours from stroke onset. Minor stroke is usually defined as NIHSS score ≤ 3 or 5,although it accounts for 1/2-2/3 of AIS, the evidence of thrombolysis is insufficient. A study from Canada shows that 28.5% of patients with minor stroke who have not receive rt-pa thrombolytic therapy are unable to walk independently when discharged. Based on such a consideration,the PRISMS study further compares the efficacy and safety of thrombolytic therapy (...) even if the patient's condition has worsened, is clinically more puzzling. The CHANCE study in 2013 shows that the efficacy of aspirin with clopidogrel is superior to aspirin alone with minor stroke (NIHSS < 3) or TIA(ABCD2 < 4). The POINT study in 2018 further confirmed the efficacy and safety of intensive antithrombotic therapy within 12 hours of onset with minor stroke. Based on the above discussion, this study aims to explore the efficacy and safety of aspirin with clopidogrel vs alteplase

2018 Clinical Trials

53. Empowerment and Mobile Technology in the Control of Cardiovascular Risk Factors in Patients With Ischemic Stroke

deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 40 Years and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Ischemic stroke or transient ischemic attack (ABCD2 score ≥3) Age ≥40 years Informed consent from the patient or legal representative

2018 Clinical Trials

54. Pragmatic trial of multifaceted intervention (STROKE-CARD care) to reduce cardiovascular risk and improve quality-of-life after ischaemic stroke and transient ischaemic attack -study protocol. Full Text available with Trip Pro

multi-domain secondary prevention, systematic detection and treatment of post-stroke complications, and patient self-empowerment. Enrolment of 2160 patients with acute ischaemic stroke or TIA (ABCD2-Score ≥ 3) is planned at two study centres in Austria. The co-primary efficacy endpoints are (i) the composite of major recurrent cardiovascular events (nonfatal stroke, nonfatal myocardial infarction, and vascular death) occurring within 12 months after the index event and (ii) one-year health-related

2018 BMC Neurology Controlled trial quality: uncertain

55. Reducing time-to-unit among patients referred to an outpatient stroke assessment unit with a novel triage process: a prospective cohort study. Full Text available with Trip Pro

for effective triage as medical intervention for true TIA/minor stroke is time-sensitive and TIA unit spots are a finite resource.Prospective cohort study design utilizing patient referral data and TIA unit arrival times from a regional fast-track TIA unit on Vancouver Island, Canada, accepting referrals from emergency departments (ED) and general practice (GP). Historical referral cohort (N = 2942) from May 2013-Oct 2014 was triaged using the ABCD2 score; prospective referral cohort (N = 2929) from Nov (...) 2014-Apr 2016 was triaged using the novel system. A retrospective survival curve analysis, censored at 28 days to unit arrival, was used to compare days to unit arrival from event date between cohort patients matched by low (0-3), moderate (4-5) and high (6-7) ABCD2 scores.Survival curve analysis indicated that using the novel triage system, prospectively referred TIA/minor stroke patients with low and moderate ABCD2 scores arrived at the unit 2 and 1 day earlier than matched historical patients

2018 BMC health services research

56. Uncertainty as a Key Influence in the Decision To Admit Patients with Transient Ischemic Attack. Full Text available with Trip Pro

administrative data to identify admission rates and chart review data to identify ABCD2 scores (a tool to classify stroke risk after TIA).Providers' decisions to admit TIA patients were related to uncertainty in several domains: lack of a facility TIA-specific policy, inconsistent use of ABCD2 score, and concerns about facilities' ability to complete a timely workup. There was a disconnect between staff perceptions about TIA admission and facility admission rates. According to chart review data, staff (...) at facilities with higher admission rates in FY 2011 reported consistent reliance on ABCD2 scores and related guidelines in admission decision-making.Many factors contributed to decisions regarding admitting a patient with TIA; however, clinicians' uncertainty appeared to be a key driver. Further quality improvement interventions for TIA care should focus on facility adoption of TIA protocols to address uncertainty in TIA admission decision-making and to standardize timely evaluation of TIA patients

2018 Journal of General Internal Medicine

57. Safety and Efficacy of RIC in Pediatric Moyamoya Disease Patients Treated With Revascularization Therapy

intervention [ Time Frame: within 7days after RIC treatment ] The investigator will record the number. The score of ABCD2 [ Time Frame: change from baseline (pre‑RIC treatment) at 180 days after revascularization therapy ] We use this scale to evaluate the patients' risk of stroke who with TIA .The score of the scale ranges from 0 to 7, and the higher score indicates higher risk of stroke in the patients who with TIA.The scale will be assessed by qualified investigator who are blinded to the treatment (...) from baseline(pre-RIC treatment) at 180 days after revascularization therapy ] cerebral perfusion status in the operation side at 6 months posttreatment as assessed by single photon emission computed tomography (SPECT). Secondary Outcome Measures : The score of National Institute of Health stroke scale score [ Time Frame: change from baseline (preoperation) at 24 hours, 48 hours, 72 hours, and at 5-7 days or if discharged earlier ] National Institute of Health Stroke Scale (NIHSS) is considered

2018 Clinical Trials

58. PRediction of Acute Coronary Syndrome in Acute Ischemic StrokE

with acute ischemic stroke admitted to the participating sites will be systematically screened for eligibility Criteria Inclusion Criteria: diagnosis of ischemic stroke based on clinical and imaging information (CT or MRI) diagnosis of transient ischemic attack if the initial focal neurological deficit has been examined by a neurologist and if the ABCD2-score is ≥ 4 Elevation of high-sensitive cardiac troponins according to the rule-in/rule-out algorithm of the 2015 ESC guidelines for NSTE-ACS, i.e (...) during the stay in hospital as well as after three and twelve months functional outcome [ Time Frame: at baseline, at one week and at three and twelve months after the initial event ] functional outcome will be evaluated using the modified Rankin scale (0-6 with greater scores indicating poorer functional outcome) cognitive outcome during inpatient stay [ Time Frame: at baseline and at one week after the initial event ] cognitive outcome will be evaluated using the Montreal Cognitive Assessment

2018 Clinical Trials

59. ED Referral Dramatically Reduces Delays of Initial Evaluation in a French TIA Clinic Full Text available with Trip Pro

years (+/-18). Median (IQR) ABCD2 score was 3 (2-4). Median (IQR) delay from onset to evaluation was 8 h (4-48). Overall, 185 (52%) were referred by OBP vs. 169 (48%) by ED. Evaluation was initiated within 12 h among 201 (57%) patients. After logistic regression, OBP referral was by comparison with ED the only independent factor associated with an evaluation delay >12 h (OR 5.7, 95% CI: 3.5-9.3, p < 0.0001). Conclusion: Our results suggest that preliminary assessment by OBP may increase the delay

2018 Frontiers in neurology

60. Inclusion of stroke in cardiovascular risk prediction instruments

to be at the same elevated risk as patients with ischemic heart disease. Patients deemed CHD riskequivalentsincludepatientswithdiabetesmellitus(DM), those whose Framingham Heart Score calculates to a risk of 20% over 10 years, and patients with “other forms of symptomatic atherosclerotic disease.” The latter group in- cludes those with peripheral arterial disease (PAD), abdom- inal aortic aneurysm (AAA), and symptomatic carotid artery disease. Ischemic stroke unrelated to carotid artery disease is Lackland et (...) Risk Score in 2008. 9 More recently,strokehasspecificallybeenproposedasapartofthe outcome cluster in absolute risk prediction instruments rele- vant to treatment decisions, 10 although this has not been generally accepted. Reasons for including stroke as an out- come in risk prediction instruments include the social and economic burden of stroke, the significance of stroke relative toCHDinsubpopulationsoftheUnitedStates,similaritiesin approachestopreventivetreatmentinstrokeasCHD,andthe inclusion

2012 American Academy of Neurology

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