Johnston S Claiborne, Rothwell Peter M, Nguyen-Huynh Mai N, Giles Matthew F, Elkins Jacob S, Bernstein Allan L, Sidney Stephen
Stroke Service, Department of Neurology, University of California, San Francisco, CA 94143-0114, USA.
Lancet. 2007 Jan 27;369(9558):283-92. doi: 10.1016/S0140-6736(07)60150-0.
We aimed to validate two similar existing prognostic scores for early risk of stroke after transient ischaemic attack (TIA) and to derive and validate a unified score optimised for prediction of 2-day stroke risk to inform emergency management.
The California and ABCD scores were validated in four independent groups of patients (n=2893) diagnosed with TIA in emergency departments and clinics in defined populations in the USA and UK. Prognostic value was quantified with c statistics. The two groups used to derive the original scores (n=1916) were used to derive a new unified score based on logistic regression.
The two existing scores predicted the risk of stroke similarly in each of the four validation cohorts, for stroke risks at 2 days, 7 days, and 90 days (c statistics 0.60-0.81). In both derivation groups, c statistics were improved for a unified score based on five factors (age >or=60 years [1 point]; blood pressure >or=140/90 mm Hg [1]; clinical features: unilateral weakness [2], speech impairment without weakness [1]; duration >or=60 min [2] or 10-59 min [1]; and diabetes [1]). This score, ABCD(2), validated well (c statistics 0.62-0.83); overall, 1012 (21%) of patients were classified as high risk (score 6-7, 8.1% 2-day risk), 2169 (45%) as moderate risk (score 4-5, 4.1%), and 1628 (34%) as low risk (score 0-3, 1.0%).
Existing prognostic scores for stroke risk after TIA validate well on multiple independent cohorts, but the unified ABCD(2) score is likely to be most predictive. Patients at high risk need immediate evaluation to optimise stroke prevention.
我们旨在验证两种现有的、用于短暂性脑缺血发作（TIA）后早期卒中风险的相似预后评分，并得出并验证一个针对预测2天卒中风险进行优化的统一评分，以为急诊管理提供参考。
加利福尼亚评分和ABCD评分在美国和英国特定人群的急诊科和诊所中，在四组独立的诊断为TIA的患者（n = 2893）中进行验证。用c统计量对预后价值进行量化。用于得出原始评分的两组患者（n = 1916）用于基于逻辑回归得出新的统一评分。
在四个验证队列中的每一个中，这两种现有评分对2天、7天和90天卒中风险的卒中预测相似（c统计量0.60 - 0.81）。在两个推导组中，基于五个因素（年龄≥60岁[1分]；血压≥140/90 mmHg[1分]；临床特征：单侧无力[2分]、无无力的言语障碍[1分]；持续时间≥60分钟[2分]或10 - 59分钟[1分]；以及糖尿病[1分]）的统一评分的c统计量得到改善。这个评分，即ABCD(2)，验证效果良好（c统计量0.62 - 0.83）；总体而言，1012名（21%）患者被归类为高危（评分6 - 7分，2天风险为8.1%），2169名（45%）为中危（评分4 - 5分，4.1%），1628名（34%）为低危（评分0 - 3分，1.0%）。
现有的TIA后卒中风险预后评分在多个独立队列中验证效果良好，但统一的ABCD(2)评分可能预测性最强。高危患者需要立即评估以优化卒中预防。
