ABCD2 Score for TIA
Age
Blood Pressure
Clinical Features
Duration of Symptoms
Diabetes
What is the ABCD2 Score?
The ABCD2 Score is a clinical prediction tool used to determine the risk of stroke after a patient has experienced a Transient Ischemic Attack (TIA). It was developed to help clinicians identify high-risk patients who may need urgent evaluation and intervention.
This validated scoring system helps stratify patients into low, moderate, and high-risk categories for developing a stroke within 2 days, 7 days, and 90 days after a TIA.
Clinical Significance
TIAs are warning signs that indicate a patient is at risk for a subsequent stroke. The ABCD2 score helps clinicians:
- Identify patients who need urgent evaluation and treatment
- Determine appropriate triage decisions (outpatient vs. inpatient management)
- Guide the intensity of secondary prevention strategies
- Communicate risk to patients and families
Risk Stratification
| ABCD2 Score | Risk Category | 2-Day Stroke Risk | 7-Day Stroke Risk | 90-Day Stroke Risk |
|---|---|---|---|---|
| 0-3 | Low | 1.0% | 1.2% | 3.1% |
| 4-5 | Moderate | 4.1% | 5.9% | 9.8% |
| 6-7 | High | 8.1% | 11.7% | 17.8% |
Management Recommendations
Low Risk (0-3 points):
- Outpatient evaluation may be appropriate
- Prompt neurovascular imaging (within 24-48 hours)
- Initiation of antiplatelet therapy
- Risk factor modification
Moderate Risk (4-5 points):
- Consider admission for observation and expedited evaluation
- Urgent neurovascular imaging
- Antiplatelet therapy
- Close monitoring for neurological deterioration
High Risk (6-7 points):
- Admission recommended
- Immediate neurovascular imaging
- Consider thrombolysis if symptoms persist and imaging is negative for hemorrhage
- Aggressive secondary prevention measures
- Evaluation for potential carotid intervention if appropriate
Limitations
While the ABCD2 score is a valuable tool, it has several limitations:
- It does not account for the etiology of the TIA
- It may not identify all high-risk patients, particularly those with large-vessel occlusions
- The score has not been validated in all populations
- Clinical judgment should always be used alongside the score
More recent scoring systems like ABCD3 and ABCD3-I incorporate additional factors such as dual TIAs and imaging findings, which may provide better risk stratification.
References
- Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283-292.
- Rothwell PM, Giles MF, Flossmann E, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet. 2005;366(9479):29-36.
- Perry JJ, Sharma M, Sivilotti ML, et al. Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ. 2011;183(10):1137-1145.