A tool as easy as ABCD to predict and prevent stroke

Lancet 2005; 366: 29-36

As many as one in five people who have a ‘mini-stroke’ or Transient Ischemic Attack (TIA), will go on to have a major stroke within a month. Supported by The Stroke Association, Professor Rothwell and his team at Oxford University have developed a simple tool, the ‘ABCD score’, as a way of identifying which people who have had a TIA are at highest risk of having a stroke. By using the 'ABCD score' patients with TIA can be assessed and treated more effectively so that more strokes are prevented.

It is well known that strokes are frequently preceded by a TIA. However, there is variation between hospitals in the way in which they manage patients with suspected TIA immediately following the TIA event. In order to effectively manage patients who have had a TIA professionals should be able to predict a patient’s subsequent risk of stroke during the first few days after the TIA. They would then be able to more quickly determine whether the patient is in need of emergency assessment, or whether the patient can be appropriately managed in a non-emergency outpatient setting.

Public awareness of the symptoms of TIA and the need to seek medical attention urgently is poor. If it was possible to predict an individual’s risk of stroke, public education about the need to seek medical attention after a TIA might be improved by focussing the public’s attention on the specific symptoms and characteristics that identify high-risk individuals.

With these issues in mind, Professor Rothwell and his team at the Stroke Prevention Research Unit, University of Oxford, developed and tested a simple 'ABCD score' that could predict the risk of stroke during the first seven days after a TIA. The score is formed from the following predictive factors as a way of quantifying the risk of stroke:

  • Age of patients
  • Blood pressure
  • The Clinical features patients presented with
  • Duration of TIA symptoms

The researchers tested the score and found an approximate 30% early risk of stroke in TIA patients with an 'ABCD score' of six.

In conclusion, the risk of stroke during the seven days after a TIA appears to be highly predictable.  Further validations of the 'ABCD score' are required, however, in the meantime, the score can be used in routine clinical practice to identify high-risk individuals who require emergency investigation and treatment.

21.06.05 Press Release - Strokes could be predicted and prevented by new test