Division of Population Health Sciences

Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn

Risk of stroke following transient ischaemic attack: The ABCD2 CPRRose Galvin, Colm Geraghty, Nicola Motterlini, Borislav D. Dimitrov, Tom Fahey

Division of Population Health Sciences

Outline

• Background

• ABCD2 CPR

• Results & quality assessment

• Discussion

Division of Population Health Sciences

Background

• Risk of stroke after TIA is significant

• Burden of stroke

• Significant challenge to clinicians to identify those at greatest risk

• Face Arm Speech Time (FAST)

Division of Population Health Sciences

FAST advertising in Ireland and UK

Age (≥60 years)Blood pressure (SBP ≥140 or DBP ≥90)Clinical features (unilateral weakness and speech impairment)Duration of symptoms (≥60 minutes and ≥ 10-59 minutes)Diabetes

0-3 4-5 6-7

Low Risk Moderate Risk High Risk

ABCD2 Clinical Prediction Rule

Management in community

Specialist assessment

within 7 days

Urgent hospital

admission (< 24 hours)

Division of Population Health Sciences

Aim

• To assess the predictive value of the ABCD2 rule in relation to – 7 & 90 day risk of stroke across the three

risk strata

Division of Population Health Sciences

Disease

risk (%)

Predicted

Observed

Risk ratio ->

Low Moderate High

Score risk

Calibration – risk ratio

Predicted

Observed

<1 “under-prediction”=1 “accurate prediction” >1 “over-prediction”

7

Pooled analysis – 7 days

Total RR(95% CI) 1.11 (0.61-2.02) 1.10 (0.75-1.62) 0.98 (0.72-2.34) I2=0% I2 =59% I2 =27% N=1933 N=2640 N=1053

Low Moderate High

12 validation studiesn= 5626

Pooled analysis – 90 daysLow Moderate High

8 validation studiesn=4897

Total RR(95% CI) 1.48 (0.86-2.55) 2.10 (1.25-3.53) 1.83 (0.92-3.65) I2=27% I2 =78% I2 =83% N=1660 N=2214 N=1033

Division of Population Health Sciences

• To assess the methodological quality of the validation studies

• 2 independent raters

• McGinn quality checklist– internal validity– external validity

Quality assessment

Quality of ABCD2 validation studies

Division of Population Health Sciences

Discussion

• ABCD2 is a useful CPR, particularly in relation to 7 day risk of stroke

• Variation in the study setting and design needs to be considered

• International consensus regarding low and high risk patients