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Presidential election years are often filled with snappy slogans. One of the best was Bill Clinton's “It's the economy, stupid” in 1992. In the campaign to prevent subsequent strokes in patients presenting with transient cerebral ischemia (TIA), we might borrow a page from Clinton's playbook.
The 90-day stroke risk after TIA is approximately 10%, half of which is front-loaded into the first 48 hours after the event.1 To identify patients at highest risk, investigators have developed risk stratification tools. The most widely used one is the 7-point ABCD2 score, which the American Heart Association (AHA) has incorporated into its TIA guideline.1 In this issue of Neurology®, Sanders et al.2 present a meta-analysis of prior studies reporting the predictive value of the ABCD2 score.
They analyzed data from over 16,000 patients, correcting for factors such as dichotomization of ABCD2 score, baseline stroke risk, and the specialty of the physician diagnosing the TIA. Overall, the area under the curve (AUC) for stroke prediction using the ABCD2 score following TIA was a respectable 0.70. But the AUC only tells part …
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