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ABCD2 Score

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121. Triple Antiplatelets for Reducing Dependency After Ischaemic Stroke

. For general information, Layout table for eligibility information Ages Eligible for Study: 50 Years and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Adults at high risk of recurrent ischaemic stroke: Age ≥ 50 years Within 48 hours of ictus (24-48 hours if thrombolysed) TIA with limb weakness and/or dysphasia lasting between 10 minutes and < 24 hours with no residual symptoms and presenting with any of the following ABCD2 score > 4

2012 Clinical Trials

122. [Acute hospitalization for TIA unnecessary]. (PubMed)

[Acute hospitalization for TIA unnecessary]. Recent findings have externally validated the usefulness of the ABCD2 score in triaging TIA patients with a high risk of early stroke in a multiethnic sample of hospitalized patients. Since this publication some neurologists in the Netherlands and in other countries have suggested that this supports guidelines that endorse the immediate hospitalization of patients with a high risk of TIA. However, no randomized trial has evaluated the benefits (...) of hospitalization or the value of the ABCD2 score in assisting with triage decisions. Current Dutch guidelines on stroke recommend the prescription of medication for secondary prevention immediately after a TIA and a full diagnostic workup within the first few days after TIA onset. In the Dutch setting, a workup in an outpatient TIA clinic is sufficient for starting secondary prevention and selecting patients likely to benefit from carotid surgery. Acute hospitalization is generally not necessary and creates

2011 Nederlands tijdschrift voor geneeskunde

123. TWO ACES: Transient Ischemic Attack Work-Up as Outpatient Assessment of Clinical Evaluation and Safety. (PubMed)

/minor stroke or possible TIA. The stroke rates at 7, 30, and 90 days were 0.6% (0.1%-3.5%) for patients referred to the TIA clinic and 1.5% (0.3%-8.0%) for the hospitalized patients. Combining both groups, the overall stroke rate was 0.9% (0.3%-3.2%), which is significantly less than expected based on ABCD2 scores (P=0.034 at 7 days and P=0.001 at 90 days).This emergency department-based inpatient versus outpatient TIA triage system led to a low rate of hospitalization (30%). Recurrent stroke rates (...) TWO ACES: Transient Ischemic Attack Work-Up as Outpatient Assessment of Clinical Evaluation and Safety. To evaluate a novel emergency department-based TIA triage system.We developed an approach to TIA triage and management based on risk assessment using the ABCD(2) score in combination with early cervical and intracranial vessel imaging. It was anticipated that this triage system would avoid hospitalization for the majority of TIA patients and result in a low rate of recurrent stroke. We

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2011 Stroke

124. Variables Associated With Discordance Between Emergency Physician and Neurologist Diagnoses of Transient Ischemic Attacks in the Emergency Department. (PubMed)

of transient ischemic attack compared with neurologist final diagnosis. Secondary goals are to evaluate the influence of atypical transient ischemic attack symptoms, the ABCD2 score, and emergency physician experience on discordant diagnoses.We performed a retrospective cohort study evaluating all ED patients receiving a diagnosis of transient ischemic attack during a 4-year period. The emergency physician diagnosis was compared with that of the neurologist. The neurologist's final diagnosis was considered (...) the criterion standard diagnosis. Subject demographic and clinical information was collected with a structured instrument. The following atypical symptoms present at the ED evaluation were evaluated with logistic regression: headache, tingling, involuntary movement, seeing flashing lights or wavy lines, dizziness, confusion, incontinence, and ABCD2 score of 4 or greater. Bivariate analysis was used to evaluate the influence of emergency physician experience (≤6 years versus >6 years) on discordant diagnosis

2011 Annals of Emergency Medicine

125. Transient Ischemic Attack Incidence in Joinville, Brazil, 2010: A Population-Based Study. (PubMed)

Transient Ischemic Attack Incidence in Joinville, Brazil, 2010: A Population-Based Study. There are scarce data on transient ischemic attack incidence in low- and middle-income countries. We aimed to measure transient ischemic attack incidence and the distribution of the ABCD2 risk score in Joinville, Brazil.In 2009 to 2010, using a multiple overlapping sources, we ascertained all first ever probable and definite transient ischemic attacks.We recorded 74 definite and probable transient ischemic (...) attacks. The crude incidence was 15 (12-18) per 100 000 population. Age adjusted to European population the incidence was 28 (22-35). One fourth was in the higher risk of stroke by the ABCD2 scale.The transient ischemic attack incidence in Joinville, Brazil, is lower than other well-designed studies. New studies could clarify whether the measured rates were due to underascertainment or reflect a truly low incidence.

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2011 Stroke

126. Stress hormones predict cerebrovascular re-events after transient ischemic attacks. (PubMed)

scoring using the ABCD2 score was determined and both hormones were measured in plasma on admission. The primary endpoint was a cerebrovascular re-event within 90 days.We included 107 consecutive patients with TIA. Re-events occurred in 10 patients (9%). Copeptin levels were higher in patients with a re-event compared with patients without re-event (p = 0.02), in contrast to cortisol (p = 0.53). Copeptin revealed a higher area under the receiver operating characteristics curve (AUC) to predict re (...) -events compared to the ABCD2 score (AUC of 0.73 vs 0.43; p < 0.01) and improved its prognostic accuracy (AUC of combined model of 0.77; p = 0.002).Measurement of plasma copeptin but not cortisol levels in patients with TIA provides additional prognostic information beyond the ABCD2 clinical risk score alone. If confirmed in future studies, routine copeptin measurement may be an additional tool for risk stratification and targeted resource allocation after TIA.

2011 Neurology

127. The Neuroprotective Effect of Remote Ischemic Preconditioning on Ischemic Cerebral Vascular Disease

, with intracranial arterial stenosis of at least 50% by angiography, at least 70% by ultrasound, or at least 70% by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) Age between 18 to 80 years old Trial of Org 10172 in Acute Stroke Treatment-1 (TOAST-1) subtype National Institutes of Health Stroke Scale (NIHSS) score 0-15, and Modified Rankin Scale (mRS) score 0-4. ABCD2 score between 6 to 7 Stable vital signs, normal hepatic and renal functions, No hemorrhagic tendencies. Exclusion

2011 Clinical Trials

128. Atherogenic Dyslipidemia in Patients With Transient Ischemic Attack. (PubMed)

of atherogenic dyslipidemia was independently associated with male sex, diabetes, and body mass index, but not with ABCD2 score. Atherogenic dyslipidemia also strongly associated with symptomatic intracranial stenosis ≥ 50% (adjusted odds ratio, 2.77; 95% CI, 1.38-5.55), but not with symptomatic extracranial stenosis ≥ 50% (adjusted odds ratio, 1.20; 95% CI, 0.64-2.26). Despite appropriate secondary prevention treatment, 90-day stroke risk was greater in patients with versus without atherogenic dyslipidemia

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2011 Stroke

129. Population-based study of risk and predictors of stroke in the first few hours after a TIA (PubMed)

Population-based study of risk and predictors of stroke in the first few hours after a TIA Several recent guidelines recommend assessment of patients with TIA within 24 hours, but it is uncertain how many recurrent strokes occur within 24 hours. It is also unclear whether the ABCD2 risk score reliably identifies recurrences in the first few hours.In a prospective, population-based incidence study of TIA and stroke with complete follow-up (Oxford Vascular Study), we determined the 6-, 12 (...) after a first TIA occurring within the first 24 hours. The 12- and 24-hour risks were strongly related to ABCD2 score (p = 0.02 and p = 0.0003). Sixteen (64%) of the 25 cases sought urgent medical attention prior to the recurrent stroke, but none received antiplatelet treatment acutely.That about half of all recurrent strokes during the 7 days after a TIA occur in the first 24 hours highlights the need for emergency assessment. That the ABCD2 score is reliable in the hyperacute phase shows

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2009 EvidenceUpdates

130. Yield of systematic transcranial Doppler in patients with transient ischemic attack. (PubMed)

Yield of systematic transcranial Doppler in patients with transient ischemic attack. Urgent evaluation and treatment of transient ischemic attack (TIA) patients in a dedicated TIA clinic may reduce the 90-day stroke risk by 80%. ABCD2 (Age, Blood pressure, Clinical features, Duration, Diabetes) score and magnetic resonance imaging abnormalities help to identify patients at high risk of stroke. Our aim was to determine whether the use of transcranial Doppler (TCD) examination on arrival (...) and 2.4% in those without (log-rank, p = 0.007). The hazard ratio of combined outcome for the presence of intracranial narrowing or occlusion was 2.29 (95% confidence interval [CI], 1.15-4.56; p = 0.02) in multivariate analysis including age, gender, hypertension, and diabetes, and was 2.50 (95%CI, 1.24-5.05; p = 0.01) in multivariate analysis including ABCD2 score > or =4.Immediate TCD examination on arrival at the TIA clinic is feasible and could help to identify patients at high risk of vascular

2010 Annals of Neurology

131. Outcomes of Atherothrombotic Transient Ischemic Attack and Minor Stroke in an Emergency Department: Results of an Outpatient Management Program. (PubMed)

, and in outpatients was 0%, 0%, and 4.2%. ABCD2 scoring in these patients predicted stroke rates of 6% at 7 days and 9.9% at 90 days.Patients with transient ischemic attack of atherothrombotic origin can be safely treated at the ED with an exhaustive diagnostic and therapeutic protocol. The rates of stroke recurrence obtained in our study are comparable with those in previous studies that show low recurrence risk.Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights

2010 Annals of Emergency Medicine

132. Stratified, Urgent Care for Transient Ischemic Attack Results in Low Stroke Rates. (PubMed)

clinic using the ABCD2 score for triage resulted in a low 90-day stroke rate for patients in the ED with TIA. Benefit occurred without requiring admission for most patients. (...) Stratified, Urgent Care for Transient Ischemic Attack Results in Low Stroke Rates. Transient ischemic attack (TIA) is a marker for early risk of stroke. No previous studies have assessed the use of urgent stroke prevention clinics for emergency department (ED) patients with TIA. We hypothesized that an ABCD2-based ED triaging tool for TIA with outpatient management would be associated with lower 90-day stroke rate than that predicted by ABCD2.A cohort of prospectively identified patients

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2010 Stroke

133. Emergency department or general practitioner following transient ischaemic attack? A comparison of patient behaviour and speed of assessment in England and Canada. (PubMed)

longer at weekends. Motor or speech symptoms and prolonged duration were associated with presenting early and to an ED. High-risk patients (ABCD2 score 6-7) in Canada were also more likely to go to an ED. Overall, 65% of Canadian patients and 40% of UK patients went to an ED.Most patients presenting to an ED go urgently, whereas most going to a GP delay, particularly at weekends. Most Canadian patients, particularly those at high risk, go to an ED whereas most UK patients go to a GP. One way

2010 Emergency Medicine Journal

134. Early clinical worsening in patients with TIA or minor stroke: the Austrian Stroke Unit Registry. (PubMed)

decompensation, acute infection, and stroke etiology emerged as independent risk predictors for early deterioration. The ABCD2 score could be estimated in a subgroup of 3,886 subjects and closely correlated with the risk of neurologic worsening.Our study revealed a high rate of early clinical deterioration (4.5%) among 8,291 patients with TIA or minor stroke despite immediate admission to specialized stroke units. Predictors for neurologic deterioration apart from diabetes, hypertension, and the estimated (...) ABCD2 score were stroke etiology, reinforcing the relevance of an immediate diagnostic workup, and coexistent acute infection and cardiac decompensation, both conditions necessitating adequate attention in the emergency setting.

2010 Neurology

135. Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: the NORTHSTAR Study (PubMed)

Prognosis in patients with transient ischaemic attack (TIA) and minor stroke attending TIA services in the North West of England: the NORTHSTAR Study The ABCD2 score predicts stroke risk within a few days of transient ischaemic attack (TIA). It is not clear whether the predictive value of the ABCD2 score can be generalised to UK TIA services, where delayed presentation of TIA and minor stroke are common. We investigated prognosis, and the use of the ABCD2 score, in patients attending TIA (...) 30 incident strokes. At least one incident TIA occurred in 100 patients (14%), but only four had a subsequent stroke. In multifactorial analyses, the ABCD2 score was unrelated to the risk of the primary outcome, but predicted the risk of incident stroke: score 4-5: hazard ratio (HR) 3.4 (95% CI 1.0 to 12); score 6-7: HR 4.8 (1.3 to 18). Of the components of the ABCD2 score, unilateral motor weakness predicted both the primary outcome (HR 1.8 (1.2 to 2.8)) and stroke risk (HR 4.2 (1.3 to 14

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2008 EvidenceUpdates

136. Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) Trial

hours of TIA or minor ischemic stroke onset in patients receiving aspirin 50-325 mg/day (with a dose of 150-200 mg daily for 5 days followed by 75-100 mg daily strongly recommended). Patients over 18 years of age with high-risk TIA (defined as an ABCD2 score greater than or equal to 4) or minor ischemic stroke (with NIHSS less than or equal to 3) who can be treated within 12 hours of time last known free of new ischemic symptoms will be enrolled. Subjects will be randomized 1:1 (clopidogrel: placebo (...) for eligibility information Ages Eligible for Study: 18 Years and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Neurological deficit (based on history or exam) attributed to focal brain ischemia and EITHER: High risk TIA: Complete resolution of the deficit at the time of randomization AND ABCD2 score of (greater than or equal to) 4 OR Minor ischemic stroke: residual deficit with NIHSS of (less than or equal to) 3 at the time

2009 Clinical Trials

137. Clopidogrel in High-risk Patients With Acute Non-disabling Cerebrovascular Events

. Symptom onset is defined by the "last see normal" principle. TIA (Neurological deficit attributed to focal brain ischemia, with resolution of the deficit within 24 hours of symptom onset), that can be treated with study drug within 24 hours of symptoms onset and with moderate-to-high risk of stroke recurrence (ABCD2 score ≥ 4 at the time of randomization). Symptom onset is defined by the "last see normal" principle. Informed consent signed Primary Efficacy Endpoint: Percentage of patients with the 3 (...) of symptom onset), that can be treated with study drug within 24 hours of symptoms onset and with moderate-to-high risk of stroke recurrence (ABCD2 score≥4 at the time of randomization).Symptom onset is defined by the "last see normal" principle Informed consent signed Exclusion Criteria: Diagnosis of hemorrhage or other pathology, such as vascular malformation, tumor, abscess or other major non-ischemic brain disease (e.g., multiple sclerosis) on baseline head CT or MRI Isolated or pure sensory symptoms

2009 Clinical Trials

138. Long-term Cardiac Monitoring After Cryptogenic Stroke (CMACS)

) Neurovascular service with cryptogenic stroke or high-risk TIA (ABCD2 score 4 or greater). Enrolled patients will be randomized in a 1:1 fashion. Group A will be assigned to wear an ambulatory cardiac event monitor for 21 days. Group B will be discharged home without a monitor and will serve as controls during routine clinical follow-up. The investigators' primary outcome will be feasibility, defined as more than 80% of randomized patients completing full clinical follow-up and more than 70% of cardiac

2009 Clinical Trials

139. Higher ABCD2 Score Predicts Patients Most Likely to Have True Transient Ischemic Attack. (PubMed)

Higher ABCD2 Score Predicts Patients Most Likely to Have True Transient Ischemic Attack. Some patients diagnosed with transient ischemic attack (TIA) in the emergency department may actually have alternative diagnoses such as seizure, migraine, or other nonvascular spells. The ABCD2 score has been shown to predict subsequent risk of stroke in patients with TIA diagnosed by emergency physicians, but perhaps high ABCD2 scores simply separate those patients with true TIA from those (...) records analyst and determined whether the spell was likely to represent a true TIA. Subsequent strokes within 90 days were identified. ABCD2 scores were calculated for all patients and 2-sided Cochrane-Armitage trend tests were used to assess subsequent risk of stroke.Of the 713 patients reviewed by the expert neurologist, 642 (90%) were judged to likely have experienced a true TIA. Ninety-day stroke risk was 24% (95% CI, 20% to 27%) in the group judged to have experienced a true TIA and 1.4% (0

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2008 Stroke

140. Transient Ischaemic Attacks

should be notified. Group 2 (lorry or bus) Licence refused or revoked for one year following a stroke or TIA. Assessment of the risk of stroke [ ] An ABCD2 score of more than 4 suggests high risk of an early stroke. Scoring System for Risk of Stroke after TIA (ABCD2 Score) A ge Age >60 years 1 BP Systolic BP >140 mm Hg and/or diastolic BP >90 mm Hg 1 C linical features Unilateral weakness 2 Speech disturbance without weakness 1 Other 0 D uration of symptoms >60 minutes 2 10-59 minutes 1 <10 minutes 0

2008 Mentor

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