Sciolla Rossella, Melis Fabio
Neurology Department, University of Turin, ASO San Luigi, Orbassano, Turin, Italy.
Stroke. 2008 Feb;39(2):297-302. doi: 10.1161/STROKEAHA.107.496612. Epub 2008 Jan 3.
A 6-point score, based on age, blood pressure, clinical features, and duration (ABCD), was shown to effectively stratify the short-term risk of stroke after a transient ischemic attack (TIA). Prospective validation in different populations of patients should precede its widespread use. Whether adding computed tomography (CT) scan findings to the score would improve its performance deserves exploring. We aimed to validate the ABCD score in a prospective cohort of patients accessing Emergency Departments within 24 hours of a TIA in an area of northern Italy and to acquire preliminary data on CT-based refinement.
During a 6-month period, all TIA patients accessing the Emergency Departments of 13 Piemonte and Valle d'Aosta hospitals were prospectively enrolled and stratified according to the 6-point ABCD score and to a 7-point score (ABCDI, where I=imaging) incorporating CT findings.
Of 274 patients, stroke occurred in 10 (3.6%) within 7 days and in 15 (5.5%) within 30 days. The ABCD score was predictive of stroke risk at both 7 and 30 days (odds ratio for every point of the score=2.55 at 7 days and 2.62 at 30 days; P for linear trend across the ABCD score levels=0.018 at 7 days and 0.0017 at 30 days). CT scan findings further increased prediction (odds ratio for every point of the score=2.68 at 7 days and 2.89 at 30 days; P for linear trend across the ABCDI score levels=0.0043 at 7 days and 0.0003 at 30 days).
The ABCD score confirmed its prognostic value in this prospective cohort. CT results could further improve prediction.
基于年龄、血压、临床特征和发作持续时间的6分制评分（ABCD），已被证明能有效分层短暂性脑缺血发作（TIA）后中风的短期风险。在其广泛应用之前，应先在不同患者群体中进行前瞻性验证。将计算机断层扫描（CT）扫描结果纳入该评分是否会提高其性能值得探索。我们旨在对意大利北部某地区在TIA发作24小时内就诊于急诊科的患者前瞻性队列中验证ABCD评分，并获取基于CT细化的初步数据。
在6个月期间，前瞻性纳入了所有就诊于13家皮埃蒙特和瓦莱达奥斯塔医院急诊科的TIA患者，并根据6分制ABCD评分以及纳入CT结果的7分制评分（ABCDI，其中I =影像学）进行分层。
274例患者中，7天内有10例（3.6%）发生中风，30天内有15例（5.5%）发生中风。ABCD评分在7天和30天时均能预测中风风险（评分每增加1分的比值比在7天时为2.55，30天时为2.62；ABCD评分各水平的线性趋势P值在7天时为0.018，30天时为0.0017）。CT扫描结果进一步提高了预测能力（评分每增加1分的比值比在7天时为2.68，30天时为2.89；ABCDI评分各水平的线性趋势P值在7天时为0.0043，30天时为0.0003）。
ABCD评分在这个前瞻性队列中证实了其预后价值。CT结果可进一步改善预测。
