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February 22, 2021
Journal Watch.
The Canadian TIA Score Is Now Prospectively Validated
Anthony S. Kim, MD reviewing Perry JJ et al. BMJ 2021 Feb 4
The score offers better performance than ABCD2 in predicting stroke risk after TIA, particularly low risk.
The elevated risk for stroke after a transient ischemic attack (TIA) presents an important opportunity for interventions to prevent an impending stroke. Simple risk stratification scores, such as the ABCD2 score, which includes just five elements (Age, Blood pressure, Clinical features, Duration of symptoms, and Diabetes) are validated for clinical use and for clinical research. But with simplicity also comes certain limitations on predictive power. The Canadian TIA Score was previously derived to stratify the short-term stroke risk after TIA. This score is composed of points for 13 clinical variables that are summed to produce a total score between –3 and +23. The variables include symptoms ≥10 minutes (+2 points), history of vertigo (–3 points), triage diastolic blood pressure ≥110 mm Hg (+3 points), atrial fibrillation (+2 points), and platelet count ≥400 x 109/liter (+2 points), and new or old infarct on noncontrast CT (+1 point). MRI data are not included.
Now investigators have prospectively validated the Canadian TIA Score in 7607 adults diagnosed with TIA or minor stroke at 13 emergency departments from 2012 to 2017. Within 7 days after the qualifying event, 108 patients (1.4%) had a stroke and 83 (1.1%) had a carotid artery revascularization procedure. The score categorized 16% of patients as having low risk (<1% risk), 72% medium risk (2.3% risk), and 12% high risk (>5% risk) and had better overall performance than the ABCD2 score, particularly for identifying low-risk patients.
COMMENT
The Canadian TIA score's complexity may require a smartphone app or website calculator to apply, but its greater clinical detail helps it to achieve more fine-tuned risk stratification than previous scores. With this prospective validation it is ready for clinical use. Future studies will evaluate the health system effects and patient outcomes of implementing care pathways for TIA that incorporate this score.
EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Anthony S. Kim, MD at time of publication
Grant/ Research Support NIH/National Institute of Neurological Disorders and Stroke; NIH/National Center for Advancing Translational Sciences; PCORI; SanBio
CITATION(S):
Perry JJ et al. Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: Multicentre prospective cohort study. BMJ 2021 Feb 4; 372:n49. (https://doi.org/10.1136/bmj.n49)
https://www.jwatch.org/na53195/2021/02/22/canadian-tia-score-now-prospectively-validated?ijkey=n6wngQcq-&fbclid=IwAR11zgkLNF8cguh0ThF3srOAjegVkMxkD5Ynr0F-MXh7sg44Jvu-y0MoMIc (https://www.jwatch.org/na53195/2021/02/22/canadian-tia-score-now-prospectively-validated?ijkey=n6wngQcq-&fbclid=IwAR11zgkLNF8cguh0ThF3srOAjegVkMxkD5Ynr0F-MXh7sg44Jvu-y0MoMIc)