Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.
Ann Emerg Med. 2010 Feb;55(2):201-210.e5. doi: 10.1016/j.annemergmed.2009.05.002. Epub 2009 Jun 25.
We evaluate, in admitted patients with transient ischemic attack, the accuracy of the ABCD(2) (age [A], blood pressure [B], clinical features [weakness/speech disturbance] [C], transient ischemic attack duration [D], and diabetes history [D]) score in predicting ischemic stroke within 7 days.
At 16 North Carolina hospitals, we enrolled a prospective, nonconsecutive sample of admitted patients with transient ischemic attack and with no stroke history, presenting within 24 hours of transient ischemic attack symptom onset. We conducted a medical record review to determine ischemic stroke outcomes within 7 days. According to a modified Rankin Scale Score, strokes were classified as disabling (>2) or nondisabling (< or =2).
During a 35-month period, we enrolled 1,667 patients, of whom 373 (23%) received a diagnosis of an ischemic stroke within 7 days. Eighteen percent (69/373) of all strokes were disabling. We were unable to calculate an ABCD(2) score in 613 patients (37%); however, our imputed analysis indicated this did not significantly alter results. The discriminatory power of the ABCD(2) score was modest for ischemic stroke in 7 days (c statistic 0.59), and fair for disabling ischemic stroke within 7 days (c statistic 0.71). Patients characterized as low risk according to ABCD(2) score (< or =3) were at low risk for experiencing a disabling stroke within 7 days, with a negative likelihood ratio of 0.16 (95% confidence interval [CI] 0.04 to 0.64) with missing values excluded and 0.34 (95% CI 0.15 to 0.76) when missing values were imputed.
Our analysis suggests the best application of the ABCD(2) score may be to identify patients at low risk for an early disabling ischemic stroke. Further study of the ability to determine an ABCD(2) score in all patients is needed, along with validation in a large, consecutive population of patients with transient ischemic attack.
我们评估了入院短暂性脑缺血发作患者中 ABCD2 评分（年龄[A]、血压[B]、临床特征[乏力/言语障碍][C]、短暂性脑缺血发作持续时间[D]和糖尿病史[D]）在预测 7 天内缺血性卒中的准确性。
在北卡罗来纳州的 16 家医院，我们前瞻性纳入了连续就诊且无卒中病史的短暂性脑缺血发作患者，在短暂性脑缺血发作症状发作后 24 小时内入院。我们进行病历回顾以确定 7 天内的缺血性卒中和残疾结局。根据改良Rankin 量表评分，卒中分为致残性（>2）和非致残性（≤2）。
在 35 个月期间，我们共纳入 1667 例患者，其中 373 例（23%）在 7 天内诊断为缺血性卒中。18%（69/373）的所有卒中为致残性。我们无法为 613 例患者（37%）计算 ABCD2 评分，但我们的推断分析表明这并未显著改变结果。ABCD2 评分对 7 天内缺血性卒中的区分能力较低（c 统计量 0.59），对 7 天内致残性缺血性卒中的区分能力尚可（c 统计量 0.71）。根据 ABCD2 评分（<或=3）判断为低危的患者在 7 天内发生致残性卒中的风险较低，排除缺失值时，阴性似然比为 0.16（95%置信区间 [CI]0.04 至 0.64），包含缺失值时为 0.34（95% CI 0.15 至 0.76）。
我们的分析表明，ABCD2 评分的最佳应用可能是识别早期发生致残性缺血性卒中风险较低的患者。需要进一步研究在所有患者中确定 ABCD2 评分的能力，并在大规模、连续的短暂性脑缺血发作患者中进行验证。
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