Urgent carotid duplex and head computed tomography versus ABCD2 score for risk stratification of patients with transient ischemic attack. (February 2016)

• Record Type: Journal Article
• Authors: Ottaviani, Maddalena; Vanni, Simone; Moroni, Federico; Peiman, Nazerian; Boddi, Maria; Grifoni, Stefano
• Is Part Of: European journal of emergency medicine. Volume 23:Number 1(2016)
• Publication Date: 2016-02
• Subjects: ABCD2 score -- carotid duplex -- head computed tomography -- transient ischemic attack; Emergency medicine -- Europe -- Periodicals; Medical emergencies -- Europe -- Periodicals; Emergency medical services -- Europe -- Periodicals; Emergencies -- Europe -- Periodicals; Emergency Medical Services -- Europe -- Periodicals; Emergency Medicine -- Europe -- periodicals; 616.025
• DOI: 10.1097/MEJ.0000000000000165
• Languages: English
• ISSNs: 0969-9546

Abstract

Abstract : Objectives: The aim of the study was to prospectively compare the prognostic value of ABCD 2 score, urgent carotid ultrasound (CUS), and unenhanced head computed tomography (UHCT) in patients presenting to the emergency department with transient ischemic attack (TIA). Patients and methods: We carried out a prospective observational study including consecutive adult patients with TIA. Each patient underwent ABCD 2 score assessment, urgent CUS, and UHCT within 24 h from presentation. The primary outcome was the occurrence of ischemic stroke within 30 days. Results: We included 186 patients with a median age of 75 years and a prevalent male sex (57.5%). During follow-up, 12 ischemic strokes (6.5%) occurred, four (7.1%) in patients with ABCD 2 score less than 4 and 8 (6.2%) in those with a score of at least 4. An internal carotid stenosis of at least 50% consistent with the neurological deficit was found in 15 patients (8.1%), and it was associated with a high risk for stroke (odds ratio 4.5, 95% confidence interval 1.1–18.8). An acute ischemic lesion consistent with the neurological deficit was revealed by UHCT in 15 patients (8.1%), and it was associated with a trend of increasing stroke risk (odds ratio 2.5, 95% confidence interval 0.5–12.5). Patients without, with at least one, or with both positive imaging tests showed incremental stroke risk at both 7 (2.5, 12.5, and 33%) and 30 days (5, 12.5, and 33%) ( P <0.05 for both). Conclusion: Simple imaging tests showed added prognostic value to ABCD 2 score in TIA patients. Urgent CUS together with UHCT should be performed in all TIA patients regardless of ABCD 2 score.