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"Anyone can do it in his head, although he will need to look up the stroke risks associated with a specific score."(Table).ĬLINICAL APPLICABILITY Johnston said he has begun using the new ABCD 2 score system in his clinical practice. The tool is easy for clinicians to use, since patients are assigned points for each risk factor, Johnston emphasized."The score is super simple," he said. The California score also was developed to predict stroke within 90 days, while the ABCD score was designed to predict stroke within 7 days. "That's why the new ABCD2 score includes both hypertension and diabetes,and both are independent predictors of 2-day outcomes," he said. Johnston said the original California and ABCD scores were very much alike: California included diabetes but not hypertension, while ABCD included hypertension but not diabetes. The authors point out that if all high-risk patients and moderate-risk patients had been admitted to the hospital, only 11 (9%) of patients who experienced stroke after TIA would not have been admitted. Of 130 patients who had a stroke within 2 days of a TIA, 111 were not admitted to the hospital, although 45 of these patients had an ABCD 2 score higher than 5.
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If these patients had been classified using the ABCD2 score, 66% would have been hospitalized and only 9% of the discharged patientswould have had a stroke, according to the researchers. The study authors pointed out that 85% of strokes occurred within 2 days after a TIA in patients who were not hospitalized. Overall, strokes occurred in 9.2% of patients within 90 days after a TIA, 7.5% at 30 days, 5.5% at 7 days, and 3.9% at 2 days. The study authors stressed that the 2-day risk of stroke after a TIAis therefore of greater clinical relevance than the 7- or 90-day risk because it determines whether the patient should be discharged or admitted. These variables are important because risk of stroke after a TIA had been previously estimated at 4% to 20%, and half of these strokes usually occur within 2 days, according to Johnston. In the 4799 patients who were tested using the newscoring system, the 2-day risk of stroke was 1.0% in the 1012 patients with a score of 0 to 3, who were deemed low-risk 4.1% in the 2169 patients with a score of 4 or 5, who were considered at moderate risk and 8.1% in the 1628 patients with a score of 6 or 7, who were deemed at high risk. The initial treating clinician determines TIA diagnosis. The new ABCD2 score, which can predict risk of stroke within 2 days after a TIA, was shown to be more accurate than the previously tested scores.
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While the California score had been developedto predict risk of stroke within 90 days after a TIA, the ABCD score predicted risk of stroke within 7 days after a TIA. THE BEST OF BOTH SCORES The new ABCD 2 score draws together elements of the California score, published in 2000 by Johnston's group, 2 and the ABCD score, published in 2003 by Rothwell and colleagues,3 and derived from the OxfordshireCommunity Stroke Project conducted through the Radcliffe Infirmary. "By working together, we came up with a single best score, validated in multiple diverse populations, andcreated a single, better standard."
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"We had validated our own score in our local population, which might have created problems with competing scores," he said. The study appears in the January issue of Lancet.īecause treatment of patients after a TIA varies between institutions, Johnston hopes the ABCD 2 score will set a precedent for treatment. Johnston 1 collaboratedwith researchers from the Radcliffe Infirmary in Oxford, UK. Claiborne Johnston, MD, PhD, assistant professor of neurology at the University of California, San Francisco, and adjunct investigator in the Division of Research, Kaiser Permanente Northern California in Oakland. The new score will help clinicians determine whether patients who have had a TIA should be admitted to the hospital to undergo urgent interventions or evaluations to prevent stroke, said S. To improve the prediction of stroke risk after a transient ischemic attack (TIA), researchers have combined the California and ABCD risk scores to create a new unified score, ABCD 2.