Optimizing the risk estimation after a transient ischaemic attack - the ABCDE⊕ score
Optimizing the risk estimation after a transient ischaemic attack - the ABCDE⊕ score
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DOI：
10.1111/j.1468-1331.2011.03428.x
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发表时间：
2012-01-01
影响因子：
5.1
通讯作者：
Lyrer, P. A.
中科院分区：
文献类型：
--
作者：
Engelter, S. T.;Amort, M.;Lyrer, P. A.
背景和目的：短暂性脑缺血发作（TIA）后卒中的风险可以通过年龄、血压、临床特征、病程（ABCD-score）和糖尿病（ABCD2-score）评分来预测。然而，根据这些评分，尽管预测风险较低，但仍有一些患者发生中风。我们设计了ABCDE+评分，将病因和弥散加权成像（DWI）上可见的缺血性病变DWI阳性变量添加到abcd评分中。我们假设这种改进增加了复发性缺血事件的可预测性。方法：我们在一所大学医院急诊科的所有连续TIA患者中进行了一项前瞻性队列研究。计算的受试者操作曲线下面积（auc）用于比较90天内卒中结局或复发性TIA评分的预测值。结果：248例患者中，33例（13.3%,95% ci 9.3-18.2%）发生卒中（n = 13）或复发性TIA （n = 20）。与无复发事件的患者相比，复发性缺血事件的患者更常以大动脉粥样硬化作为TIA的原因（46%对14%，P < 0.001）和DWI阳性（61%对35%，P = 0.01）。有和没有事件的患者在年龄、临床症状、持续时间、血压、危险因素和卒中预防治疗方面没有差异。auc比较[95% CI]显示ABCDE+评分（0.67[0.55-0.75]）优于ABCD 2评分（0.48[0.37-0.58],P = 0.04），且优于ABCD-评分（0.50[0.40-0.61],P = 0.07）。结论：在TIA患者中，在abcd评分中加入“病因学”和“dwi阳性”变量似乎可以增强对随后脑缺血事件的可预测性。
Background and purpose: The risk of stroke after a transient ischaemic attack (TIA) can be predicted by scores incorporating age, blood pressure, clinical features, duration (ABCD-score), and diabetes (ABCD2-score). However, some patients have strokes despite a low predicted risk according to these scores. We designed the ABCDE+ score by adding the variables etiology and ischaemic lesion visible on diffusion-weighted imaging (DWI) DWI-positivity to the ABCD-score. We hypothesized that this refinement increases the predictability of recurrent ischaemic events. Methods: We performed a prospective cohort study amongst all consecutive TIA patients in a university hospital emergency department. Area under the computed receiver-operating curves (AUCs) were used to compare the predictive values of the scores with regard to the outcome stroke or recurrent TIA within 90 days. Results: Amongst 248 patients, 33 (13.3%, 95%-CI 9.3-18.2%) had a stroke (n = 13) or a recurrent TIA (n = 20). Patients with recurrent ischaemic events more often had large-artery atherosclerosis as the cause for TIA (46% vs. 14%, P < 0.001) and positive DWI (61% vs. 35%; P = 0.01) compared with patients without recurrent events. Patients with and those without events did not differ with regard to age, clinical symptoms, duration, blood pressure, risk factors, and stroke preventive treatment. The comparison of AUCs [95% CI] showed superiority of the ABCDE+ score (0.67[0.55-0.75]) compared to the ABCD 2 -score (0.48[0.37-0.58]; P = 0.04) and a trend toward superiority compared to the ABCD-score (0.50[0.40-0.61]; P = 0.07). Conclusion: In TIA patients, the addition of the variables 'etiology' and 'DWI-positivity' to the ABCD-score seems to enhance the predictability of subsequent cerebral ischaemic events.