TIA? Is a stroke to follow?

9 Aug

A 2000 cohort study established 5 criteria that can predict the risk for TIA patients of having a stroke within 90 days of their TIA.

  • Age over 60,
  • Diabetes,
  • Duration of episode over 10 minutes,
  • weakness with the episode,
  • speech impairment with the episode.

90-day risk of stroke:

  • 5 criteria, the risk is 34%
  • 4 out of 5 criteria: 15%.
  • 3 criteria: 11%,
  • 2 criteria: 7%,
  • 1 criteria: 3%,
  • no criteria: 0%.

 

A similar criteria is the ABCD2 score,

  • 1 point for age over 60,
  • 1 point BP over 140/90,
  • 2 points for weakness, 
    • 1 point for speech disturbance without weakness
  • 2 points for duration of symptoms > 60 minutes, 
    • 1 point for duration of symptoms 10-59 min

7-day risk

  • 0.4% with a score less than 5,
  • 12.1% (CI 4.2–20.0) with a score of 5,
  • 31.4% (CI 16.0–46.8) with a score of 6. 

 

COMMON THEMES:

higher near and future risk with more risk factors (e.g. age >60, diabetes, BP >140/90 at presentation)

longer duration of TIA is higher risk (> 10 min, >60 min)

more symptoms with TIA, higher risk (speech problems, +/-weakness)

 

BOTTOM LINE:

more or less common sense (more medical risk factors, more or longer symptoms, higher risk for future stroke), but gives you some numbers/evidence if you’re fighting for an admission, or debating yourself what to do for your next TIA patient

 

Submitted by C. Stokes.

 

References: Johnston SC, et al. Short-Term Prognosis after Emergency Department Diagnosis of TIA. JAMA. 2000; 284(22): 2901-2906; ABCD Score article; Josephson, SA, et al. Higher ABCD2 Score Predicts Patients Most Likely to Have True Ischemic Attack. Stoke. 2008; 39: 3096-3098; picture

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