ABCD score

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A stroke risk stratification score. Stated as ABCD: Age, Blood pressure, Clinical features, Duration[1][2].

ABCD score for stroke risk after TIA
Feature 0 1 2
Age 0 if <60 years 1 if ≥60 years
Blood pressure 0 otherwise 1 if systolic >140 mm Hg and/or diastolic ⩾90 mm Hg
Clinical Features 0 otherwise 1 if speech disturbance without weakness 2 if unilateral weakness
Duration 0 if less than 10 minutes 1 if 10 to 59 minutes 2 if ⩾60 minutes

Some add a further point for diabetes.

  • 6-7 high risk
  • 4-5 moderate risk
  • 0-3 low risk

Validated stratification suggests a score of 5 or greater out of 6 predicts a group with high 7-day risk of ischaemic stroke in a range of patient populations in the UK[3][4] but it may not be that useful in populations from other cultures[5][6]. It can be used in populations similar to that it was validated in to guide the need for immediate hospital admission[7]There is a fair correlation with the results of early cerebral diffusion-weighted MR imaging (within 48 hours)[8] and this itself may be a useful stratification tool[9][10]. Three month risk of ischaemic stroke is independently predicted by the ABCD score and early diffusion MRI[11]. The more recently validated ABCD2 score is likely to replace it in clinical practice.

References

  1. Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet. 2005 Jul 2-8; 366(9479):29-36.(Link to article – subscription may be required.)
  2. Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007 Jan 27; 369(9558):283-92.(Link to article – subscription may be required.)
  3. Bray JE, Coughlan K, Bladin C. Can the ABCD Score be dichotomised to identify high-risk patients with transient ischaemic attack in the emergency department? Emergency medicine journal : EMJ. 2007 Feb; 24(2):92-5.(Link to article – subscription may be required.)
  4. Tsivgoulis G, Spengos K, Manta P, Karandreas N, Zambelis T, Zakopoulos N, Vassilopoulos D. Validation of the ABCD score in identifying individuals at high early risk of stroke after a transient ischemic attack: a hospital-based case series study. Stroke; a journal of cerebral circulation. 2006 Dec; 37(12):2892-7.(Link to article – subscription may be required.)
  5. Cucchiara BL, Messe SR, Taylor RA, Pacelli J, Maus D, Shah Q, Kasner SE. Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack? Stroke; a journal of cerebral circulation. 2006 Jul; 37(7):1710-4.(Link to article – subscription may be required.)
  6. Purroy García F, Molina Cateriano CA, Montaner Villalonga J, Delgado Martínez P, Santmarina Pérez E, Toledo M, Quintana M, Alvarez Sabín J. Lack of usefulness of ABCD score in the early risk of recurrent stroke in transient ischemic attack patients. Medicina clínica. 2007 Feb 17; 128(6):201-3.
  7. Byrne A, Daly C, Rocke L, Gray J. Can risk stratification of transient ischaemic attacks improve patient care in the emergency department? Emergency medicine journal : EMJ. 2007 Sep;24(9):637-40.(Link to article – subscription may be required.)
  8. Redgrave JN, Schulz UG, Briley D, Meagher T, Rothwell PM. Presence of acute ischaemic lesions on diffusion-weighted imaging is associated with clinical predictors of early risk of stroke after transient ischaemic attack. Cerebrovascular diseases (Basel, Switzerland). 2007; 24(1):86-90.(Link to article – subscription may be required.)
  9. Hill MD, Weir NU. Is the ABCD score truly useful? Stroke; a journal of cerebral circulation. 2006 Jul;37(7):1636.(Link to article – subscription may be required.)
  10. Redgrave JN, Coutts SB, Schulz UG, Briley D, Rothwell PM. Systematic review of associations between the presence of acute ischemic lesions on diffusion-weighted imaging and clinical predictors of early stroke risk after transient ischemic attack. Stroke; a journal of cerebral circulation. 2007 May; 38(5):1482-8.(Link to article – subscription may be required.)
  11. Calvet D, Lamy C, Touzé E, Oppenheim C, Meder JF, Mas JL. Management and outcome of patients with transient ischemic attack admitted to a stroke unit. Cerebrovascular diseases (Basel, Switzerland). 2007; 24(1):80-5.(Link to article – subscription may be required.)