The ABCD2 Score for Stroke Risk After TIA
The ABCD2 Score is a clinical prediction rule used to estimate the short-term risk of a stroke following a Transient Ischemic Attack (TIA). It helps clinicians identify high-risk individuals who require urgent hospitalization and immediate neurovascular workup.
The score is calculated by assigning points across five distinct clinical variables.
ABCD2 Scoring Criteria
The total score ranges from 0 to 7 points, calculated as follows:
A - Age: Greater than or equal to 60 years (+1 point)
B - Blood Pressure: Systolic blood pressure greater than or equal to 140 mmHg OR diastolic blood pressure greater than or equal to 90 mmHg at initial evaluation (+1 point)
C - Clinical Features of the TIA:
Unilateral weakness (with or without speech impairment) (+2 points)
Speech impairment alone (without unilateral weakness) (+1 point)
D - Duration of Symptoms:
Greater than or equal to 60 minutes (+2 points)
10 to 59 minutes (+1 point)
Less than 10 minutes (+0 points)
2 - Diabetes: History of diabetes mellitus (+1 point)
Risk Stratification and 2-Day Stroke Risk
The total cumulative score categorizes patients into three distinct risk tiers, predicting the likelihood of a subsequent stroke within 48 hours:
Score 0 to 3 (Low Risk): Approximately 1.0% risk of stroke within 2 days. Outpatient evaluation may be considered if rapid specialty follow-up is available.
Score 4 to 5 (Moderate Risk): Approximately 4.1% risk of stroke within 2 days. Hospital admission is typically indicated for expedited neuroimaging and workup.
Score 6 to 7 (High Risk): Approximately 8.1% risk of stroke within 2 days. Requires immediate hospital admission, urgent neuroimaging (diffusion-weighted MRI), and initiation of secondary prevention strategies.
ABCD2 Score References
Johnston, S. C., Rothwell, P. M., Nguyen-Huynh, M. N., et al. (2007). Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. The Lancet, 369(9558), 283-292.
Rothwell, P. M., Giles, M. F., Flossmann, E., et al. (2005). A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. The Lancet, 366(9479), 29-36.
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