ABCD² Score
Stroke risk assessment after a transient ischemic attack (TIA).
Understanding and Using the ABCD² Score
The ABCD² score is an internationally validated prognostic tool designed to identify and stratify the early risk of ischemic stroke in the first hours and days following a Transient Ischemic Attack (TIA). Developed in 2007 by Johnston et al., it allows emergency physicians and neurologists to quickly identify patients requiring urgent hospitalization.
Components of the Clinical Evaluation
The acronym ABCD² refers to the five independent clinical parameters that make up the score:
- A (Âge) : Un âge de 60 ans ou plus est un facteur de risque majeur (+1 point).
- B (Blood Pressure) : Une pression artérielle initiale élevée (≥ 140/90 mmHg) témoigne d\'une instabilité hémodynamique (+1 point).
- C (Clinical features) : La présentation clinique est le facteur le plus déterminant. Un déficit moteur unilatéral est fortement prédictif d\'un AVC imminent (+2 points), suivi par un trouble du langage isolé (+1 point).
- D (Durée) : Plus les symptômes de l\'AIT durent longtemps, plus le risque d\'infarctus constitué augmente. Une durée ≥ 60 minutes ajoute 2 points.
- D (Diabète) : La présence d\'un diabète de type 1 ou 2 fragilise le réseau vasculaire et majore le risque (+1 point).
Clinical Limits & Imaging (AHA/ESO Guidelines)
While very useful for rapid triage in the ER, recent guidelines (AHA/ASA, ESO) emphasize that the ABCD² score has limitations. It does not account for neuroimaging data. A low score does not formally rule out a high risk if carotid stenosis or an ischemic lesion on MRI is present. It is highly recommended to complete the evaluation with imaging and use the ABCD³-I score if possible.
Post-TIA Stroke Risk Stratification
| Total Score | Risk Level | 2-Day Stroke Risk |
|---|---|---|
| 0 - 3 points | Faible | 1.0 % |
| 4 - 5 points | Modéré | 4.1 % |
| 6 - 7 points | Élevé | 8.1 % |
References:
1. Johnston SC, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007.
[PubMed]
2. Perry JJ, et al. Prospective validation of the ABCD2 score for patients in the emergency department with transient ischemic attack. CMAJ. 2011.
[PubMed]
-
💡 Committed to scientific accuracy, if you notice any clinical or technical discrepancy, please let us know.