Post-Transient Ischemic Attack Early Stroke Stratification: The ABCD2 Prognostic Aid

Carpenter, Christopher R.; Keim, Samuel M.; Crossley, John; Perry, Jeffrey J.; Best Evidence in Emergency Medicine Investigator Group,

doi:10.1016/j.jemermed.2008.04.034

« Previous Next »The Journal of Emergency Medicine
Volume 36, Issue 2 , Pages 194-200, February 2009

Post-Transient Ischemic Attack Early Stroke Stratification: The ABCD² Prognostic Aid

Christopher R. Carpenter, MD, MSC, FAAEM
- Washington University School of Medicine in St. Louis, St. Louis, Missouri
Samuel M. Keim, MD, MS
- Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona
- Reprint Address: Samuel M. Keim, md, ms, Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ 85724-5057
John Crossley, MD, CCFP(EM), FRCP(C)
- Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada
Jeffrey J. Perry, MD, MSC, CCFP(EM)
- Department of Emergency Medicine, University of Ottawa/Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
Best Evidence in Emergency Medicine Investigator Group
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

Received 21 November 2007; received in revised form 4 March 2008; accepted 26 March 2008. published online 10 November 2008.

Abstract

Background: In many patients, transient ischemic attack (TIA) precedes stroke. Prompt recognition of TIA patients who are at increased short-term risk for stroke may facilitate efficient resource utilization and improved patient outcomes. Three prognostic decision aids have been derived and validated to empower emergency physicians to stratify TIA patients for 2-day stroke risk based upon information readily available at the bedside. Clinical Question: Can a TIA stratification tool predict short-term stroke risk? Evidence Review: Two relevant tool derivation studies and one validation study were selected from an evidence search and a structured review. Results: The three tools reveal similar prognostic capabilities, although the ABCD² prognostic guide may be slightly superior. A proposal scoring system for TIA patients at low risk for stroke within 90 days is presented. Conclusion: Stroke risk stratification is possible with a simple prediction rule.

Keywords: evidence-based medicine, EBM, clinical decision rules, transient ischemic attack, stroke, prognosis