Brief Reports

Use of the ABCD2 Score Helps Predict True Ischemic Stroke in Dizzy Patients

By Matthew E. Fink, MD

Interim Chair and Neurologist-in-Chief, Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY

Dr. Fink is a retained consultant for MAQUET. This article originally appeared in the July issue of Neurology Alert.

Source: Navi BB, et al. Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department. Stroke 2012;43:1484-1489.

THE ABCD2 SCORE REFERS TO A NUMERICAL SCALE, 0 TO 7, based on a series of clinical features (age > 60, blood pressure > 140/90, clinical features such as weakness or speech disturbance, duration of symptoms > 10 minutes, presence of diabetes) that predicts with a high degree of validity a true ischemic TIA/stroke and helps to distinguish this from other disorders that may mimic a stroke (Lancet 2007;369:283-292). The authors reviewed the charts of 907 dizzy patients who presented to the emergency department at UCSF. Thirty-seven (4.1%) had a cerebrovascular cause, of which 24 were ischemic strokes. The median ABCD2 score was 3, and the score predicted the ultimate diagnosis of a cerebrovascular event (c statistic, 0.79; 95% confidence interval, 0.73-0.85). Only 5 of 512 patients (1%) with a score of ≤ 3 had a cerebrovascular event, compared to 25 of 369 patients (6.8%) with a score of 4 or 5, and 7 of 26 patients (27%) who had a score of 6 or 7. Use of this score in the emergency department may help to stratify low-risk vs high-risk patients and result in more rational and efficient use of scarce resources.