Interobserver agreement in ABCD scoring between non-stroke specialists and vascular neurologists following suspected TIA is only fair
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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.
KeywordsTransient ischaemic attack ABCD score Risk stratification Non-vascular neurologist Interobserver agreement
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.
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