Triaging TIA/Minor Stroke Patients using the ABCD² Score Does Not Predict those with Significant Carotid Disease

详细信息	查看全文 | 推荐本文 |

• 作者：J. Walker^a ; J. Isherwood^a ; D. Eveson^b ; A.R. Naylor^a ; ^{ross.naylor@uhl-tr.nhs.uk}
• 关键词：Stroke ; TIA ; ABCD2 score ; Carotid stenosis
• 刊名：European Journal of Vascular and Endovascular Surgery
• 出版年：2012
• 期刊代码：122_10785884
• 类别：med
• 出版时间：May, 2012
• 卷：43
• 期：5
• 页码：495-498
• 文件大小：165 K

摘要

Background

鈥楻apid Access鈥?TIA Clinics use the ABCD² score to triage patients as it is not possible to see everyone with a suspected TIA <24聽h. Those scoring 0-3 are seen within seven days, while patients scoring 4-7 are seen as soon as possible (preferably <24聽h). It was hypothesized that patients scoring 4-7 would have a higher yield of significant carotid disease.

Methods

Prospective study of correlation between Family Doctor (FD) or Emergency Department (ED) ABCD² score and specialist consultant Stroke Physician measured ABCD² score and prevalence of 鈮?0%ipsilateral carotid stenosis or occlusion in patients presenting with 鈥榓ny territory鈥?TIA/minor stroke or 鈥榗arotid territory鈥?TIA/minor stroke.

Results

Between 1.10.2008 and 31.04.2011, 2452 patients were referred to the Leicester Rapid Access TIA Service. After Stroke Physician review, 1273 (52%) were thought to have suffered a minor stroke/TIA. Of these, both FD/ED referrer and Specialist Stroke Consultant ABCD² scores and carotid Duplex ultrasound studies were available for 843 (66%). The yield for identifying a 鈮?0%stenosis or carotid occlusion was 109/843 (12.9%) in patients with 鈥榓ny territory鈥?TIA/minor stroke and 101/740 (13.6%) in those with a clinical diagnosis of 鈥榗arotid territory鈥?TIA/minor stroke. There was no association between ABCD² score and the likelihood of encountering significant carotid disease and analyses of the area under the receiver operating characteristic curve (AUC) for FD/ED referrer and stroke specialist ABCD² scores showed no prediction of carotid stenosis (FD/ED: AUC 0.50 (95%CI 0.44-0.55, p聽=聽0.9), Specialist: AUC 0.51 (95%CI 0.45-0.57, p聽=聽0.78).

Conclusions

The ABCD² score was unable to identify TIA/minor stroke patients with a higher prevalence of clinically important ipsilateral carotid disease.