Department of Neurology, The Adelaide and Meath Hospital, Dublin incorporating National Children's Hospital, Trinity College Dublin, Tallaght, Dublin, 24, Ireland.
J Neurol. 2011 Jun;258(6):1001-7. doi: 10.1007/s00415-010-5870-3. Epub 2010 Dec 25.
The appropriateness of use and accuracy of age, blood pressure, clinical features and duration of symptoms (ABCD) scoring by non-stroke specialists while risk-stratifying patients with suspected transient ischaemic attack (TIA) are unknown. We reviewed all available ABCD data from referrals to a specialist neurovascular clinic. ABCD scoring was defined as 'appropriate' in this study if an experienced vascular neurologist subsequently confirmed a clinical diagnosis of possible, probable or definite TIA, and 'inappropriate' if the patient had an alternative diagnosis or stroke. Interobserver agreement between the referring physician and the neurologist was calculated. One hundred and four patients had completed ABCD referral proformas available for analysis. Forty-five (43%) were deemed appropriate, and 59 (57%) inappropriate. In the entire dataset, the neurologist agreed with the referring physician's total ABCD score in only 42% of cases [κ = 0.28]. The two most unreliable components of the scoring system were clinical features [κ = 0.51], and duration of symptoms [κ = 0.48]. ABCD scoring by non-stroke specialists is frequently inappropriate and inaccurate in routine clinical practice, emphasising the importance of urgent specialist assessment of suspected TIA patients.
非卒中专家在对疑似短暂性脑缺血发作（TIA）患者进行风险分层时，ABCD 评分的使用是否恰当以及年龄、血压、临床特征和症状持续时间（ABCD）评分的准确性如何尚不清楚。我们回顾了转诊至神经血管专科诊所的所有可用 ABCD 数据。在本研究中，如果经验丰富的血管神经病学家随后证实了可能、很可能或明确 TIA 的临床诊断，则将 ABCD 评分定义为“恰当”，否则如果患者有其他诊断或卒中，则为“不恰当”。计算了转诊医生和神经科医生之间的观察者间一致性。104 名患者完成了 ABCD 转诊预填表，可进行分析。45 名（43%）被认为是恰当的，59 名（57%）不恰当。在整个数据集，在 42%的病例中，神经科医生与转诊医生的总 ABCD 评分仅一致[κ=0.28]。评分系统中最不可靠的两个部分是临床特征[κ=0.51]和症状持续时间[κ=0.48]。非卒中专家在常规临床实践中 ABCD 评分常常不恰当且不准确，这强调了对疑似 TIA 患者进行紧急专科评估的重要性。
