Age but not ABCD(2) score predicts any level of carotid stenosis in either symptomatic or asymptomatic side in transient ischaemic attack

G S Mannu, M M Kyu, J H Bettencourt-Silva, Y K Loke, A B Clark, A K Metcalf, J F Potter, P K Myint

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The ABCD(2) score is routinely used in assessment of transient ischaemic attack (TIA) to assess the risk of developing stroke. There remains uncertainty regarding whether the ABCD(2) score could be used to help predict extent of carotid artery stenosis (CAS).

OBJECTIVES: We aimed to (i) collate and analyse all available published literature on this topic and (ii) compare the data from our local population to the existing evidence base.

MATERIALS AND METHODS: We conducted a retrospective-observational study over a 6-month period using our East of England hospital-based TIA clinic data with a catchment population of ~750,000. We also searched the literature on studies reporting the association between ABCD(2) score and CAS.

RESULTS: We included 341 patients in our observational study. The mean age in our cohort was 72.86 years (SD 10.91) with 52% male participants. ABCD(2) score was not significantly associated with CAS (p = 0.78). Only age > 60 years was significantly associated with ipsilateral (> 50%) and contralateral CAS (> 50% and > 70%) (p < 0.01) after controlling for other confounders. The systematic review identified four studies for inclusion and no significant association between ABCD(2) score and CAS was reported, confirming our findings.

CONCLUSION: Our systematic review and observational study confirm that the ABCD(2) score does not predict CAS. However, our observational study has examined a larger number of possible predictors and demonstrates that age appears to be the single best predictor of CAS in patients presenting with a TIA. Selection of urgent carotid ultrasound scan thus should be based on individual patient's age and potential benefit of carotid intervention rather than ABCD(2) score.

Original languageEnglish
Pages (from-to)948-956
Number of pages9
JournalInternational Journal of Clinical Practice
Volume69
Issue number9
Early online date1 Apr 2015
DOIs
Publication statusPublished - Sep 2015

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Carotid Stenosis
Transient Ischemic Attack
Observational Studies
England
Population
Uncertainty
Retrospective Studies
Stroke

Keywords

  • Transient Iscahaemic attack
  • Age
  • ABCD2
  • Cartoid Stenosis

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Age but not ABCD(2) score predicts any level of carotid stenosis in either symptomatic or asymptomatic side in transient ischaemic attack. / Mannu, G S; Kyu, M M; Bettencourt-Silva, J H; Loke, Y K; Clark, A B; Metcalf, A K; Potter, J F; Myint, P K.

In: International Journal of Clinical Practice, Vol. 69, No. 9, 09.2015, p. 948-956.

Research output: Contribution to journalArticle

Mannu, G S ; Kyu, M M ; Bettencourt-Silva, J H ; Loke, Y K ; Clark, A B ; Metcalf, A K ; Potter, J F ; Myint, P K. / Age but not ABCD(2) score predicts any level of carotid stenosis in either symptomatic or asymptomatic side in transient ischaemic attack. In: International Journal of Clinical Practice. 2015 ; Vol. 69, No. 9. pp. 948-956.
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abstract = "BACKGROUND: The ABCD(2) score is routinely used in assessment of transient ischaemic attack (TIA) to assess the risk of developing stroke. There remains uncertainty regarding whether the ABCD(2) score could be used to help predict extent of carotid artery stenosis (CAS).OBJECTIVES: We aimed to (i) collate and analyse all available published literature on this topic and (ii) compare the data from our local population to the existing evidence base.MATERIALS AND METHODS: We conducted a retrospective-observational study over a 6-month period using our East of England hospital-based TIA clinic data with a catchment population of ~750,000. We also searched the literature on studies reporting the association between ABCD(2) score and CAS.RESULTS: We included 341 patients in our observational study. The mean age in our cohort was 72.86 years (SD 10.91) with 52{\%} male participants. ABCD(2) score was not significantly associated with CAS (p = 0.78). Only age > 60 years was significantly associated with ipsilateral (> 50{\%}) and contralateral CAS (> 50{\%} and > 70{\%}) (p < 0.01) after controlling for other confounders. The systematic review identified four studies for inclusion and no significant association between ABCD(2) score and CAS was reported, confirming our findings.CONCLUSION: Our systematic review and observational study confirm that the ABCD(2) score does not predict CAS. However, our observational study has examined a larger number of possible predictors and demonstrates that age appears to be the single best predictor of CAS in patients presenting with a TIA. Selection of urgent carotid ultrasound scan thus should be based on individual patient's age and potential benefit of carotid intervention rather than ABCD(2) score.",
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author = "Mannu, {G S} and Kyu, {M M} and Bettencourt-Silva, {J H} and Loke, {Y K} and Clark, {A B} and Metcalf, {A K} and Potter, {J F} and Myint, {P K}",
note = "{\circledC} 2015 John Wiley & Sons Ltd. Funding: No funding was obtained for this study. Norfolk and Norwich Stroke & TIA register is maintained by the Stroke Services, Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUHFT). JHBS is supported by the Research & Development Department of the NNUHFT through research capability funding arrangement. Acknowledgements: We acknowledge the Stroke Research Data team and the Norfolk and Norwich University Hospital stroke and TIA register steering committee for their support in this study.",
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TY - JOUR

T1 - Age but not ABCD(2) score predicts any level of carotid stenosis in either symptomatic or asymptomatic side in transient ischaemic attack

AU - Mannu, G S

AU - Kyu, M M

AU - Bettencourt-Silva, J H

AU - Loke, Y K

AU - Clark, A B

AU - Metcalf, A K

AU - Potter, J F

AU - Myint, P K

N1 - © 2015 John Wiley & Sons Ltd. Funding: No funding was obtained for this study. Norfolk and Norwich Stroke & TIA register is maintained by the Stroke Services, Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUHFT). JHBS is supported by the Research & Development Department of the NNUHFT through research capability funding arrangement. Acknowledgements: We acknowledge the Stroke Research Data team and the Norfolk and Norwich University Hospital stroke and TIA register steering committee for their support in this study.

PY - 2015/9

Y1 - 2015/9

N2 - BACKGROUND: The ABCD(2) score is routinely used in assessment of transient ischaemic attack (TIA) to assess the risk of developing stroke. There remains uncertainty regarding whether the ABCD(2) score could be used to help predict extent of carotid artery stenosis (CAS).OBJECTIVES: We aimed to (i) collate and analyse all available published literature on this topic and (ii) compare the data from our local population to the existing evidence base.MATERIALS AND METHODS: We conducted a retrospective-observational study over a 6-month period using our East of England hospital-based TIA clinic data with a catchment population of ~750,000. We also searched the literature on studies reporting the association between ABCD(2) score and CAS.RESULTS: We included 341 patients in our observational study. The mean age in our cohort was 72.86 years (SD 10.91) with 52% male participants. ABCD(2) score was not significantly associated with CAS (p = 0.78). Only age > 60 years was significantly associated with ipsilateral (> 50%) and contralateral CAS (> 50% and > 70%) (p < 0.01) after controlling for other confounders. The systematic review identified four studies for inclusion and no significant association between ABCD(2) score and CAS was reported, confirming our findings.CONCLUSION: Our systematic review and observational study confirm that the ABCD(2) score does not predict CAS. However, our observational study has examined a larger number of possible predictors and demonstrates that age appears to be the single best predictor of CAS in patients presenting with a TIA. Selection of urgent carotid ultrasound scan thus should be based on individual patient's age and potential benefit of carotid intervention rather than ABCD(2) score.

AB - BACKGROUND: The ABCD(2) score is routinely used in assessment of transient ischaemic attack (TIA) to assess the risk of developing stroke. There remains uncertainty regarding whether the ABCD(2) score could be used to help predict extent of carotid artery stenosis (CAS).OBJECTIVES: We aimed to (i) collate and analyse all available published literature on this topic and (ii) compare the data from our local population to the existing evidence base.MATERIALS AND METHODS: We conducted a retrospective-observational study over a 6-month period using our East of England hospital-based TIA clinic data with a catchment population of ~750,000. We also searched the literature on studies reporting the association between ABCD(2) score and CAS.RESULTS: We included 341 patients in our observational study. The mean age in our cohort was 72.86 years (SD 10.91) with 52% male participants. ABCD(2) score was not significantly associated with CAS (p = 0.78). Only age > 60 years was significantly associated with ipsilateral (> 50%) and contralateral CAS (> 50% and > 70%) (p < 0.01) after controlling for other confounders. The systematic review identified four studies for inclusion and no significant association between ABCD(2) score and CAS was reported, confirming our findings.CONCLUSION: Our systematic review and observational study confirm that the ABCD(2) score does not predict CAS. However, our observational study has examined a larger number of possible predictors and demonstrates that age appears to be the single best predictor of CAS in patients presenting with a TIA. Selection of urgent carotid ultrasound scan thus should be based on individual patient's age and potential benefit of carotid intervention rather than ABCD(2) score.

KW - Transient Iscahaemic attack

KW - Age

KW - ABCD2

KW - Cartoid Stenosis

U2 - 10.1111/ijcp.12637

DO - 10.1111/ijcp.12637

M3 - Article

C2 - 25832133

VL - 69

SP - 948

EP - 956

JO - International Journal of Clinical Practice

JF - International Journal of Clinical Practice

SN - 1368-5031

IS - 9

ER -