Comparison of ABCD2 scoring between first healthcare-contact and stroke-specialist physicians for transient ischaemic attack in a rapid-access clinic

SIR—The ABCD2 stroke risk scoring system based on clinical features found to be independently predictive of stroke following TIA is now in widespread use [1–4]. The Department of Health for England (DoH) aims for 60% of patients with ABCD2 scores of ≥4 at presentation to complete specialist assessment within 24 h of first healthcare-contact and those scoring <4 within 7 days [5]. A systematic review of studies evaluating ABCD2 and its prediction of stroke risk found the greatest predictive value to be where score derivation had been conducted by stroke specialists through face-to-face consultation or retrospective secondary-care case notes review. Studies involving score derivation from retrospective review of emergency department (ED) case notes show ABCD2 to have a much poorer predictive value [1, 2, 6]. To date, studies of ABCD2 use by non-specialists are lacking, yet the urgency of specialist review is mostly based upon this mode of assessment. Non-specialist versus specialist derivation of ABCD2 cannot necessarily be assumed to result in the same score. The stroke specialist is forearmed to identify and extract the expected clinical features from a clinical history. Recall of events may change over time and blood pressure levels can be highly variable after TIA [7–9]. A prospective study of referrer ABCD2 scores, in comparison with that by specialists is therefore warranted. In this study, scores generated by the referrer and specialist in confirmed cases of TIA attending a daily clinic were compared.