Can ABCD score predict the need for in-hospital intervention in patients with transient ischemic attacks?

BACKGROUND

The ABCD(2) score is increasingly being used to triage patients with transient ischemic attack (TIA). Whether the score can predict the need for in-hospital intervention (IHI), other than initiation of antiplatelets and statins, is unknown.

AIMS: The ability of the ABCD(2) score to predict IHI would strengthen the rationale to use it as a decision-making tool. We thus conducted this study to investigate the relationship between the ABCD(2) score and IHI.

METHODS

We analyzed prospectively collected data from consecutive TIA patients over 12 months. We determined ABCD(2) upon admission and collected the results of in-hospital evaluation, treatments initiated during hospitalization, and follow-up status. We defined IHI as arterial revascularization or anticoagulation required during admission. We used chi-square for trend to examine the association between ABCD(2) and IHI.

RESULTS

We studied 121 patients. Fourteen (12%) had small infarcts on diffusion magnetic resonance imaging; 38 (31%) had a new risk factor recognized during admission [hyperlipidemia (n = 9), hypertension (1), diabetes (1), carotid stenosis >/= 50% (16), other arterial occlusive lesions (7), and potential cardioembolic source (4)]. Their percentages increased with higher ABCD(2) scores. However, among 12 patients (10%) with IHI, ABCD(2) score categories were equally distributed (10% in 0-3, 9% in 4-5, and 10% in 6-7; p = 0.8). One patient (0.8%) worsened during hospitalization; none had a stroke during follow-up.

CONCLUSION

Patients with an ABCD(2) score </= 3 had an equal chance of requiring IHI as those with a score of 4-7. The decision to admit TIA patients based on the ABCD(2) score alone is not supported by our experience and requires further study.