Division of Population Health Sciences Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn Risk of stroke following transient ischaemic attack: The ABCD 2 CPR Rose Galvin, Colm Geraghty, Nicola Motterlini, Borislav D. Dimitrov, Tom Fahey

Division of Population Health Sciences Outline Background ABCD 2 CPR Results & quality assessment Discussion

Division of Population Health Sciences Background Risk of stroke after TIA is significant Burden of stroke Significant challenge to clinicians to identify those at greatest risk Face Arm Speech Time (FAST)

Division of Population Health Sciences FAST advertising in Ireland and UK

Age (≥ 60 years) Blood pressure (SBP ≥ 140 or DBP ≥ 90 ) Clinical features (unilateral weakness and speech impairment) Duration of symptoms ( ≥ 60 minutes and ≥ minutes) Diabetes Low RiskModerate RiskHigh Risk ABCD 2 Clinical Prediction Rule Management in community Specialist assessment within 7 days Urgent hospital admission (< 24 hours)

Division of Population Health Sciences Aim To assess the predictive value of the ABCD 2 rule in relation to –7 & 90 day risk of stroke across the three risk strata

Division of Population Health Sciences Disease risk (%) Predicted Observed Risk ratio -> Low Moderate High Score risk Calibration – risk ratio Predicted Observed <1 “under-prediction” =1 “accurate prediction” >1 “over-prediction” 7

Pooled analysis – 7 days Total RR( 95 % CI) 1.11 ( ) 1.10 ( ) 0.98 ( ) I 2 =0% I 2 =59% I 2 =27% N=1933 N=2640 N=1053 Low Moderate High 12 validation studies n= 5626

Pooled analysis – 90 days Low Moderate High 8 validation studies n= 4897 Total RR( 95 % CI) 1.48 ( ) 2.10 ( ) 1.83 ( ) I 2 =27% I 2 =78% I 2 =83% N=1660 N=2214 N=1033

Division of Population Health Sciences To assess the methodological quality of the validation studies 2 independent raters McGinn quality checklist –internal validity –external validity Quality assessment

Quality of ABCD 2 validation studies

Division of Population Health Sciences Discussion ABCD 2 is a useful CPR, particularly in relation to 7 day risk of stroke Variation in the study setting and design needs to be considered International consensus regarding low and high risk patients