Long-term risk of stroke after transient ischaemic attack: a hospital-based validation of the ABCD(2) rule

BACKGROUND: The ABCD(2) clinical prediction rule is a seven point summation of clinical factors independently predictive of stroke risk. The purpose of this cohort study is to validate the ABCD(2) rule in a Bulgarian hospital up to three years after TIA. METHODS: All consecutive admissions to an emergency department with symptoms of a first TIA were included. Baseline data and clinical examinations including the ABCD(2) scores were documented by neurologists. Discrimination and calibration performance was examined using ABCD(2) cut-off scores of ≥3, ≥4 and ≥5 points, consistent with the international guidelines. The Hosmer-Lemeshow test was used to examine calibration between the observed and expected outcomes as predicted by ABCD(2) score within the logistic regression analysis. RESULTS: Eighty-nine patients were enrolled to the study with a mean age of 63 years (+/- 12 years). Fifty-nine percent (n = 53) of the study population was male. Seven strokes (7 · 8%) occurred within the first year and six further strokes within the three-year follow-up period. There was no incident of stroke within the first 90 days after TIA. The rule demonstrated good predictive (OR = 1 · 58, 95% CI 1 · 09-2 · 29) and discriminative performance (AUC(ROC) = 0 · 72, 95% CI 0 · 58-0 · 86), as well as a moderate calibration performance at three years. CONCLUSION: This validation of the ABCD(2) rule in a Bulgarian hospital demonstrates that the rule has good predictive and discriminative performance at three years. The ABCD(2) is quick to administer and may serve as a useful tool to assist clinicians in the long-term management of individuals with TIA.