Post-Transient Ischemic Attack Early Stroke Stratification: The ABCD² Prognostic Aid

Background: In many patients, transient ischemic attack (TIA) precedes stroke. Prompt recognition of TIA patients who are at increased short-term risk for stroke may facilitate efficient resource utilization and improved patient outcomes. Three prognostic decision aids have been derived and validated to empower emergency physicians to stratify TIA patients for 2-day stroke risk based upon information readily available at the bedside. Clinical Question: Can a TIA stratification tool predict short-term stroke risk? Evidence Review: Two relevant tool derivation studies and one validation study were selected from an evidence search and a structured review. Results: The three tools reveal similar prognostic capabilities, although the ABCD² prognostic guide may be slightly superior. A proposal scoring system for TIA patients at low risk for stroke within 90 days is presented. Conclusion: Stroke risk stratification is possible with a simple prediction rule.