Abstract
BackgroundThe ABCD2 clinical prediction rule is a seven point summation of clinical factors independently predictive of stroke risk. The purpose of this cohort study is to validate the ABCD2 rule in a Bulgarian hospital up to three years after TIA.MethodsAll consecutive admissions to an emergency department with symptoms of a first TIA were included. Baseline data and clinical examinations including the ABCD2 scores were documented by neurologists. Discrimination and calibration performance was examined using ABCD2 cut-off scores of ≥3, ≥4 and ≥5 points, consistent with the international guidelines. The Hosmer-Lemeshow test was used to examine calibration between the observed and expected outcomes as predicted by ABCD2 score within the logistic regression analysis.ResultsEighty-nine patients were enrolled to the study with a mean age of 63 years (+/- 12 years). Fifty-nine percent (n = 53) of the study population was male. Seven strokes (7 · 8%) occurred within the first year and six further strokes within the three-year follow-up period. There was no incident of stroke within the first 90 days after TIA. The rule demonstrated good predictive (OR = 1 · 58, 95% CI 1 · 09-2 · 29) and discriminative performance (AUCROC = 0 · 72, 95% CI 0 · 58-0 · 86), as well as a moderate calibration performance at three years.ConclusionThis validation of the ABCD2 rule in a Bulgarian hospital demonstrates that the rule has good predictive and discriminative performance at three years. The ABCD2 is quick to administer and may serve as a useful tool to assist clinicians in the long-term management of individuals with TIA.
Highlights
The ABCD2 clinical prediction rule is a seven point summation of clinical factors independently predictive of stroke risk
A recent systematic review reported that the seven day pooled stroke risk after Transient ischaemic attack (TIA) was 6 · 2% but there was substantial heterogeneity between the primary studies included in the review with risks ranging from 0% to 18 · 7% [2]
Studies have attempted to validate the rule to predict long term risk of stroke after TIA [11,12,13]. While these studies have reported that the rule has moderate predictive and discriminative ability, the widespread applicability of the ABCD2 score to predict long-term risk of stroke after TIA depends on its consistency of performance in different studies and settings [10]
Summary
Study design and setting The Plovdiv project is a hospital-based cohort study from 2002–2005, designed to determine predictors of incidence and prognosis of major vascular events including the recurrence of cerebrovascular or cardiovascular events. Our study represents a secondary analysis of data collected from a prospective cohort of consecutive patients, presenting with symptoms of TIA to the emergency department at the University Hospital, Medical University of Plovdiv, Bulgaria. Baseline data and the clinical examinations, including those contained in the ABCD2 score, were documented by the study neurologists at the recruitment of patients. 2×2 cross-tables were used to calculate discriminative accuracy (sensitivity and specificity) at ≥3, ≥4 and ≥5 points on the ABCD2 rule These different cut-points are used to identify people at low and high risk of stroke following TIA in several international guidelines on the management of patients with TIA. Calibration (or reliability) reflects how closely predicted outcomes agree with the actual outcomes For this purpose, the Hosmer-Lemeshow test (HLT) was used for comparison between the observed outcomes and those expected as predicted by ABCD2 score within the logistic regression analysis. All statistical analyses were completed using STATA (version 12, Stata Corp, College Station, Texas, USA) and IBM SPSS Statistics (Ver., IBM Corporation, USA)
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