Sunday, October 19, 2008

Scoring Stroke Risk

A simple scoring system was recently published defining characteristics of patients with TIA that would increase their risk for stroke within seven days. The method is called the ABCD Scoring System. Scores are assigned for the following
variables:

A - Age: greater than or equal to 60 years = 1 point
B - Blood pressure: systolic greater than 140mmHg, or diastolic greater than 90mmHg = 1 point
C - Clinical features: unilateral weakness = 2 points; speech disturbance without weakness = 1 point
D - Duration of symptoms: greater than or equal to 60 minutes = 2 points; 10-59 minutes = 1 point

Totals:
Less than or equal to 4: the risk of stroke within 7 days is very low (0.4%)
5 points: the risk of stroke within 7 days is 12.1%
6 points: the risk of stroke within 7 days is 31.4%

Now that we know which patients are most likely to have a stroke within a short period of time after TIA, it is time to teach those patients the signs and symptoms of stroke so that they will seek treatment promptly. If your patient presents to the Emergency Department within the first hour of stroke symptoms thrombolytics and angiography may be possible, later presentations limit treatment choices.

From: Rothwell, P.M., et al. (2005). A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischemic attack. Lancet, 366: 29-36.
Best wishes,

David W. Woodruff, MSN, RN, CNS
President, Ed4Nurses, Inc.
www.Ed4Nurses.com

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