Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack
Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack
复制标题
DOI：
10.1016/s0140-6736(07)60150-0
复制
发表时间：
2007-01-01
期刊：
影响因子：
168.9
通讯作者：
Sidney, Stephen
中科院分区：
文献类型：
--
作者：
Johnston, S. Claiborne;Rothwell, Peter M.;Sidney, Stephen
背景：我们的目的是验证两种类似的短暂性缺血性发作（TIA）后早期卒中风险的现有预后评分，并得出并验证一个统一的评分，该评分优化用于预测2天卒中风险，为应急管理提供信息。方法对美国和英国四组独立的TIA患者（n=2893）进行加利福尼亚和ABCD评分验证。用c统计量量化预后价值。使用推导原始分数的两组（n=1916），根据逻辑回归推导出新的统一分数。在4个验证队列中，现有的两种评分对2天、7天和90天卒中风险的预测相似（c统计值0.60-0.81）。在两个衍生组中，c：统计数据在基于5个因素（年龄60岁[1分]；血压>= 140/90 mm Hg[1]；临床特征：单侧无力[2]，无无力言语障碍[1]；持续时间>= 60 min[2]或10-59 min[1]；糖尿病[1]）的统一评分方面得到改善。该评分ABCD(2)验证良好（c统计值0.62-0.83）；总体而言，1012例（21%）患者被归为高风险（评分6-7,2天风险8.1%），2169例（45%）患者被归为中度风险（评分4-5,4.1%），1628例（34%）患者被归为低风险（评分0-3,1.0%）。提示：TIA后卒中风险的现有预后评分在多个独立队列中验证良好，但统一的ABCD(2)评分可能是最具预测性的。高危患者需要立即评估以优化卒中预防。
Background We aimed to validate two similar existing prognostic scores for early risk of stroke after transient ischaemic attack (TIA) and to derive and validate a unified score optimised for prediction of 2-day stroke risk to inform emergency management.Methods The California and ABCD scores were validated in four independent groups of patients (n=2893) diagnosed with TIA in emergency departments and clinics in defined populations in the USA and UK. Prognostic value was quantified with c statistics. The two groups used to derive the original scores (n=1916) were used to derive a new unified score based on logistic regression.Findings The two existing scores predicted the risk of stroke similarly in each of the four validation cohorts, for stroke risks at 2 days, 7 days, and 90 days (c statistics 0.60-0.81). in both derivation groups, c: statistics were improved for a unified score based on five factors (age 60 years [1 point]; blood pressure >= 140/90 mm Hg [1]; clinical features: unilateral weakness [2], speech impairment without weakness [1]; duration >= 60 min [2] or 10-59 min [1]; and diabetes [1]). This score, ABCD(2), validated well (c statistics 0.62-0.83); overall, 1012 (21%) of patients were classified as high risk (score 6-7, 8.1% 2-day risk), 2169 (45%) as moderate risk (score 4-5, 4.1%), and 1628 (34%) as low risk (score 0-3, 1.0%).Implications Existing prognostic scores for stroke risk after TIA validate well on multiple independent cohorts, but the unified ABCD(2) score is likely to be most predictive. Patients at high risk need immediate evaluation to optimise stroke prevention.