ABCD2 scores and prediction of noncerebrovascular diagnoses in an outpatient population: a case-control study

Quinn, T.J. , Cameron, A., Dawson, J. , Lees, K.R. and Walters, M.R. (2009) ABCD2 scores and prediction of noncerebrovascular diagnoses in an outpatient population: a case-control study. Stroke, 40(3), pp. 749-753. (doi:10.1161/STROKEAHA.108.530444)

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Publisher's URL: http://dx.doi.org/10.1161/STROKEAHA.108.530444

Abstract

<p><b>Background and Purpose:</b> Among patients with transient ischemic attack, the ABCD2 score predicts short-term stroke risk. Use of the ABCD2 score assumes the underlying diagnosis to be transient ischemic attack; however, most transient ischemic attack services assess a variety of diagnoses. We hypothesized that patients with low ABCD2 score predominantly have noncerebrovascular diagnoses.</p> <p><b>Methods:</b> Our transient ischemic attack clinics assess all suspected cerebrovascular events referred. Comprehensive clinical and investigation details are prospectively recorded. We collated data for patients seen between August 1992 and January 2005 inclusive. We calculated ABCD2 scores and compared proportions of noncerebrovascular diagnoses for each ABCD2 grade using {chi}2 analysis. We ran similar analyses for atrial fibrillation, vascular lesions on brain imaging, and carotid stenosis. We calculated positive predictive value of low (0 to 1) ABCD2 score for noncerebrovascular diagnosis and described properties of ABCD2 as a diagnostic tool using receiver operating characteristic curves.</p> <p><b>Results:</b> We derived ABCD2 scores for 3646 patients of whom 1769 had a noncerebrovascular diagnosis. There was a positive association between increasing ABCD2 score and cerebrovascular diagnosis (P<0.001). Higher ABCD2 score was associated with vascular lesions on brain imaging (P<0.001) and moderate–severe carotid disease (P<0.001) but not atrial fibrillation (P=0.097). The positive predictive value of low ABCD score was 0.81 for noncerebrovascular diagnosis and 0.93 for negative imaging. Receiver operating characteristic curve analysis suggested reasonable accuracy (area under the curve, 0.745).</p> <p><b>Conclusion:</b> For low scores, ABCD2 may assist in selecting out noncerebrovascular diagnoses. However, this approach will potentially misclassify many true transient ischemic attacks. Further refinement would be needed before clinical application.</p>

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Lees, Professor Kennedy and Cameron, Professor Alan and Quinn, Dr Terence and Dawson, Professor Jesse and Walters, Professor Matthew
Authors: Quinn, T.J., Cameron, A., Dawson, J., Lees, K.R., and Walters, M.R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Stroke
Publisher:American Heart Association
ISSN:0039-2499
ISSN (Online):1524-4628
Published Online:15 January 2009
Copyright Holders:Copyright © 2009 American Heart Association
First Published:First published in Stroke 40(3):749-753
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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