Low positive predictive value of the ABCD² score in emergency department transient ischaemic attack diagnoses: the South Western Sydney Transient Ischaemic Attack Study

Authors: Ghia, D.; Thomas, P.; Cordato, D.; Epstein, D.; Beran, R. G.; Cappelen-Smith, C.; Griffith, N.; Hanna, I.; McDougall, A.; Hodgkinson, S. J.; Worthington, J. M.

Source: Internal Medicine Journal, Volume 42, Number 8, 1 August 2012 , pp. 913-918(6)

Publisher: Wiley-Blackwell

Abstract:

<title type="main">Abstract</title>

Background:  The ABCD² stroke risk score is recommended in national guidelines for stratifying care in transient ischaemic attack (TIA) patients, based on its prediction of early stroke risk. We had become concerned about the score accuracy and its clinical value in modern TIA cohorts.

Methods:  We identified emergency department-diagnosed TIA at two hospitals over 3 years (2004-2006). Cases were followed for stroke occurrence and ABCD² scores were determined from expert record review. Sensitivity, specificity and positive predictive values (PPV) of moderate-high ABCD² scores were determined.

Results:  There were 827 indexed TIA diagnoses and record review was possible in 95.4%. Admitted patients had lower 30-day stroke risk (n= 0) than discharged patients (n= 7; 3.1%) (P < 0.0001). There was no significant difference in proportion of strokes between those with a low or moderate-high ABCD² score at 30 (1.2 vs 0.8%), 90 (2.0 vs 1.9%) and 365 days (2.4 vs 2.4%) respectively. At 30 days the sensitivity, specificity and PPV of a moderate-high score were 57% (95% confidence interval (CI) 25.0-84.2), 32.2% (95% CI 29.1-35.6) and 0.75% (95% CI 0.29-1.91) respectively.

Conclusions:  Early stroke risk was low after an emergency diagnosis of TIA and significantly lower in admitted patients. Moderate-high ABCD² scores did not predict early stroke risk. We suggest local validation of ABCD² before its clinical use and a review of its place in national guidelines.

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1445-5994.2011.02564.x

Publication date: 2012-08-01

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• By this author: Ghia, D. ;  Thomas, P. ;  Cordato, D. ;  Epstein, D. ;  Beran, R. G. ;  Cappelen-Smith, C. ;  Griffith, N. ;  Hanna, I. ;  McDougall, A. ;  Hodgkinson, S. J. ;  Worthington, J. M.

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