ABCD2, ABCD2-I, and OTTAWA scores for stroke risk assessment: a direct retrospective comparison

Abstract

Transient ischemic attack (TIA) is a neurologic emergency characterized by cerebral ischemia eliciting a temporary focal neurological deficit. Many clinical prediction scores have been proposed to assess the risk of stroke after TIA; however, studies on their clinical validity and comparisons among them are scarce. The objective is to compare the accuracy of ABCD², ABCD²-I, and OTTAWA scores in the prediction of a stroke at 7, 90 days, and 1 year in patients presenting with TIA. Single-centre, retrospective study including patients with TIA admitted to the Emergency Department of our third-level, University Hospital, between 2018 and 2019. Five hundred three patients were included. Thirty-nine (7.7%) had a stroke within 1 year from the TIA: 9 (1.7%) and 24 (4.7%) within 7 and 90 days, respectively. ABCD², ABCD²-I, and OTTAWA scores were significantly higher in patients who developed a stroke. AUROCs ranged from 0.66 to 0.75, without statistically significant differences at each time-point. Considering the best cut-off of each score, only ABCD² > 3 showed a sensitivity of 100% only in the prediction of stroke within 7 days. Among clinical items of each score, duration of symptoms, previous TIA, hemiparesis, speech disturbance, gait disturbance, previous cerebral ischemic lesions, and known carotid artery disease were independent predictors of stroke. Clinical scores have moderate prognostic accuracy for stroke after TIA. Considering the independent predictors for stroke, our study indicates the need to continue research and prompts the development of new tools on predictive scores for TIA.

Keywords: Acute stroke; Clinical predictive score; Emergency medicine; Transient ischemic attack.

Fig. 1

AUROCs of investigated scores at each time-point (7, 90 days and 1 year). For stroke within 7 days, ABCD², ABCD²-I, and OTTAWA scores had an AUROC 0.73 (95% CI 0.61–083), 0.75 (95% CI 0.61–0.88), and 0.66 (95% CI 0.48–0.83), respectively; for stroke within 90 days, an AUROC of 0.75 (95% CI 0.71–0.78), 0.74 (95% CI 0.71–0.87), and 0.71 (95% CI 0.67–0.75), respectively; for stroke within 1 year, an AUROC of 0.69 (95% CI 0.65–0.73), 0.69 (95% CI 0.64–0.72), and 0.70 (95% CI 0.66–0.74), respectively