Advertisement

Journal of Neurology

, Volume 258, Issue 6, pp 1001–1007 | Cite as

Interobserver agreement in ABCD scoring between non-stroke specialists and vascular neurologists following suspected TIA is only fair

  • Justin A. Kinsella
  • W. Oliver Tobin
  • Nicola Cogan
  • Dominick J. H. McCabe
Original Communication

Abstract

The appropriateness of use and accuracy of age, blood pressure, clinical features and duration of symptoms (ABCD) scoring by non-stroke specialists while risk-stratifying patients with suspected transient ischaemic attack (TIA) are unknown. We reviewed all available ABCD data from referrals to a specialist neurovascular clinic. ABCD scoring was defined as ‘appropriate’ in this study if an experienced vascular neurologist subsequently confirmed a clinical diagnosis of possible, probable or definite TIA, and ‘inappropriate’ if the patient had an alternative diagnosis or stroke. Interobserver agreement between the referring physician and the neurologist was calculated. One hundred and four patients had completed ABCD referral proformas available for analysis. Forty-five (43%) were deemed appropriate, and 59 (57%) inappropriate. In the entire dataset, the neurologist agreed with the referring physician’s total ABCD score in only 42% of cases [κ = 0.28]. The two most unreliable components of the scoring system were clinical features [κ = 0.51], and duration of symptoms [κ = 0.48]. ABCD scoring by non-stroke specialists is frequently inappropriate and inaccurate in routine clinical practice, emphasising the importance of urgent specialist assessment of suspected TIA patients.

Keywords

Transient ischaemic attack ABCD score Risk stratification Non-vascular neurologist Interobserver agreement 

Notes

Acknowledgments

Dr Kinsella’s research is funded by the Stanley Thomas Johnson Foundation, and by unrestricted educational grant funding from Bayer Schering Ireland, Pfizer Ireland and Elitech UK. Dr Tobin’s research is funded by the IICN-Serono Fellowship programme, the Meath Foundation, the Lundbeck Neurosciences Bursary programme, and unrestricted educational grant funding from Merck Serono Ireland, Brennan and Company Ireland and Biogen Idec Ireland Limited. Dr McCabe supervised all the above research. No specific funding was sought or obtained for the completion of this study.

Conflicts of interest

We confirm that none of the authors have any conflicts of interest or any other disclosures to report. None of the above grant bodies had any influence over the design or conduct of the study, or the analysis or interpretation of the data. The authors had sole responsibility for the decision to submit the manuscript for publication.

References

  1. 1.
    Cucchiara BL, Messe SR, Taylor RA, Pacelli J, Maus D, Shah Q, Kasner SE (2006) Is the ABCD score useful for risk stratification of patients with acute transient ischemic attack? Stroke 37:1710–1714PubMedCrossRefGoogle Scholar
  2. 2.
    Giles MF, Albers GW, Amarenco P, Arsava MM, Asimos A, Ay H, Calvet D, Coutts S, Cucchiara BL, Demchuk AM, Johnston SC, Kelly PJ, Kim AS, Labreuche J, Lavallee PC, Mas JL, Merwick A, Olivot JM, Purroy F, Rosamond WD, Sciolla R, Rothwell PM (2010) Addition of brain infarction to the ABCD2 Score (ABCD2I): a collaborative analysis of unpublished data on 4574 patients. Stroke 41:1907–1913PubMedCrossRefGoogle Scholar
  3. 3.
    Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM (2006) Distinguishing between stroke and mimic at the bedside: the brain attack study. Stroke 37:769–775PubMedCrossRefGoogle Scholar
  4. 4.
    Johnston SC, Rothwell PM, Nguyen-Huynh MN, Giles MF, Elkins JS, Bernstein AL, Sidney S (2007) Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet 369:283–292PubMedCrossRefGoogle Scholar
  5. 5.
    Josephson SA, Sidney S, Pham TN, Bernstein AL, Johnston SC (2008) Higher ABCD2 score predicts patients most likely to have true transient ischemic attack. Stroke 39:3096–3098PubMedCrossRefGoogle Scholar
  6. 6.
    Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, Lovelock CE, Binney LE, Bull LM, Cuthbertson FC, Welch SJ, Bosch S, Alexander FC, Silver LE, Gutnikov SA, Mehta Z (2007) Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet 370:1432–1442PubMedCrossRefGoogle Scholar
  7. 7.
    Rothwell PM, Giles MF, Flossmann E, Lovelock CE, Redgrave JN, Warlow CP, Mehta Z (2005) A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack. Lancet 366:29–36PubMedCrossRefGoogle Scholar
  8. 8.
    Tsivgoulis G, Spengos K, Manta P, Karandreas N, Zambelis T, Zakopoulos N, Vassilopoulos D (2006) Validation of the ABCD score in identifying individuals at high early risk of stroke after a transient ischemic attack: a hospital-based case series study. Stroke 37:2892–2897PubMedCrossRefGoogle Scholar
  9. 9.
    Weir NU, Buchan AM (2005) A study of the workload and effectiveness of a comprehensive acute stroke service. J Neurol Neurosurg Psychiatry 76:863–865PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Justin A. Kinsella
    • 1
  • W. Oliver Tobin
    • 1
  • Nicola Cogan
    • 1
  • Dominick J. H. McCabe
    • 1
    • 2
  1. 1.Department of NeurologyThe Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Trinity College DublinDublinIreland
  2. 2.Department of Clinical Neurosciences, Royal Free CampusUCL Institute of NeurologyLondonUK

Personalised recommendations