Can ABCD2 score predict the need for in-hospital intervention in patients with transient ischemic attacks?

Abstract

BackgroundThe ABCD2 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.AimsThe ability of the ABCD2 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 ABCD2 score and IHI.MethodsWe analyzed prospectively collected data from consecutive TIA patients over 12 months. We determined ABCD2 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 ABCD2 and IHI.ResultsWe 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 ABCD2 scores. However, among 12 patients (10%) with IHI, ABCD2 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.ConclusionPatients with an ABCD2 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 ABCD2 score alone is not supported by our experience and requires further study.