Royal College of Surgeons in Ireland Col

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Royal College of Surgeons in IrelandColáiste
Ríoga na Máinleá in Éirinn
Risk of stroke following transient ischaemic
attack The ABCD2 CPR Rose Galvin, Colm Geraghty,
Nicola Motterlini, Borislav D. Dimitrov, Tom Fahey
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Outline

• Background
• ABCD system
• Results quality assessment
• Discussion

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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)

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ABCD system

• ABCD2 CPR
• amalgamation of 2 CPRs
• 7 point rule
• summation of clinical signs and symptoms

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ABCD2 CPR
Age (60 years) Blood pressure (SBP 140 or DBP
90) Clinical features (unilateral weakness and
speech impairment) Duration of symptoms Diabetes
0-3
4-5
6-7
Low Risk
Moderate Risk
High Risk
Management in community
Specialist assessment within 7 days
Urgent hospital admission (lt 24 hours)
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Aim

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

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Data analysis

• Derivation study used as a predictive model
• Results presented as ratio measurement
• predicted number of strokes by ABCD2 rule
• observed number of strokes in validation study

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Pooled analysis 7 days
Low Moderate High
Total RR(95 CI) 1.11 (0.61-2.02) 1.10
(0.75-1.62) 0.98 (0.72-2.34)
I20 I2 59 I2 27
N1933 N1640 N1053
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Pooled analysis 90 days
Low Moderate High
Total RR(95 CI) 1.48 (0.86-2.55) 2.10
(1.25-3.53) 1.83 (0.92-3.65)
I227 I2 78 I2 83
N1660 N2214
N1033
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Quality assessment

• To assess the methodological quality of the
  validation studies
• 2 independent raters
• McGinn quality checklist
• internal validity
• external validity

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Quality of ABCD2 validation studies
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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