Mannu G S, Kyu M M, Bettencourt-Silva J H, Loke Y K, Clark A B, Metcalf A K, Potter J F, Myint P K
Oxford University Hospitals NHS Trust, Oxford, UK.
Norfolk and Norwich University Hospital, Norfolk, UK.
Int J Clin Pract. 2015 Sep;69(9):948-56. doi: 10.1111/ijcp.12637. Epub 2015 Apr 1.
The ABCD(2) score is routinely used in assessment of transient ischaemic attack (TIA) to assess the risk of developing stroke. There remains uncertainty regarding whether the ABCD(2) score could be used to help predict extent of carotid artery stenosis (CAS).
We aimed to (i) collate and analyse all available published literature on this topic and (ii) compare the data from our local population to the existing evidence base.
We conducted a retrospective-observational study over a 6-month period using our East of England hospital-based TIA clinic data with a catchment population of ~750,000. We also searched the literature on studies reporting the association between ABCD(2) score and CAS.
We included 341 patients in our observational study. The mean age in our cohort was 72.86 years (SD 10.91) with 52% male participants. ABCD(2) score was not significantly associated with CAS (p = 0.78). Only age > 60 years was significantly associated with ipsilateral (> 50%) and contralateral CAS (> 50% and > 70%) (p < 0.01) after controlling for other confounders. The systematic review identified four studies for inclusion and no significant association between ABCD(2) score and CAS was reported, confirming our findings.
Our systematic review and observational study confirm that the ABCD(2) score does not predict CAS. However, our observational study has examined a larger number of possible predictors and demonstrates that age appears to be the single best predictor of CAS in patients presenting with a TIA. Selection of urgent carotid ultrasound scan thus should be based on individual patient's age and potential benefit of carotid intervention rather than ABCD(2) score.
ABCD(2)评分常用于短暂性脑缺血发作（TIA）的评估，以评估发生中风的风险。关于ABCD(2)评分是否可用于帮助预测颈动脉狭窄（CAS）的程度，仍存在不确定性。
我们旨在（i）整理和分析关于该主题的所有已发表文献，以及（ii）将我们当地人群的数据与现有证据基础进行比较。
我们使用英格兰东部以医院为基础的TIA诊所数据进行了一项为期6个月的回顾性观察研究，该诊所服务人口约75万。我们还检索了关于报告ABCD(2)评分与CAS之间关联的研究的文献。
我们的观察性研究纳入了341例患者。我们队列的平均年龄为72.86岁（标准差10.91），男性参与者占52%。ABCD(2)评分与CAS无显著相关性（p = 0.78）。在控制其他混杂因素后，仅年龄>60岁与同侧（>50%）和对侧CAS（>50%和>70%）显著相关（p < 0.01）。系统评价确定了四项纳入研究，未报告ABCD(2)评分与CAS之间存在显著关联，证实了我们的研究结果。
我们的系统评价和观察性研究证实，ABCD(2)评分不能预测CAS。然而，我们的观察性研究检查了更多可能的预测因素，并表明年龄似乎是TIA患者中CAS的唯一最佳预测因素。因此，紧急颈动脉超声扫描的选择应基于个体患者的年龄和颈动脉干预的潜在益处，而不是ABCD(2)评分。
