Ischaemic strokes are frequently preceded by a TIA. North American and UK guidelines state that all patients in whom a diagnosis of TIA is suspected should be assessed and investigated in 7 days. However, this aim is frequently not achieved in practice. The effective early management of patients with TIA is undermined by an inability to predict who is at highest early risk of stroke.
Peter Rothwell (University of Oxford, UK) and colleagues derived a simple score based on age, blood pressure, clinical features, and duration of symptoms (ABCD) by studying risk factors for stroke in around 200 patients with a probable or definite TIA. The investigators then tested the risk score in two separate groups of similar patients. They found that the risk of stroke during the first 7 days after TIA was highly predictable.
Professor Rothwell states: "Although further validations and refinements are needed, the ABCD score can be used in routine clinical practice to identify high-risk individuals who need emergency investigation and treatment."
The researchers also found that in the UK, most strokes that occurred in the first few days and weeks after a TIA occurred in patients who have been referred to a hospital clinic for investigation but had not yet been seen. The authors believe that the guidelines on the urgency with which TIA patients are investigated should be revised.
The authors also state that their results can help with public education about the warning symptoms of stroke. Professor Rothwell comments: "Public education about the need to seek medical attention urgently after a TIA has been difficult thus far because of the wide variety of possible symptoms of TIA. However, our results show that the vast majority early strokes occur after TIAs with a few specific symptoms. These results should allow public education to be effectively focused." (Quote by e-mail; does not appear in published paper.)
Contact: Dr Peter M Rothwell, Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Road, Oxford, OX2 6HE, UK. T) 01865 224237 peter.rothwell@clinical-neurology.oxford.ac.uk
The Stroke Association press office on 07799 436 008 press@stroke.org.uk
Journal
The Lancet