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ABCD2 & Stroke Risk

A stroke is a traumatic event that can have dire and long-lasting consequences if treatment is not obtained promptly. According to the Centers for Disease Control, stroke is the nation's third-leading cause of death. A stroke happens when a blood clot blocks an artery that supplies the brain or an artery bursts. Either scenario causes the brain to be starved of blood and brain cells to die. The ABCD2 scoring system was developed to help physicians assess the risk of stroke.

  1. About TIA

    • A transient ischemic attack, sometimes called a "mini-stroke," has symptoms of stroke but usually lasts less than 24 hours. Caused by a partial blockage of an artery, it is a warning that a more-serious stroke can occur. Emergency physicians often use the ABCD2 rule to help them decide whether to admit a TIA patient to the hospital immediately or whether the patient is probably safe to go home and to follow up later with his primary physician and a neurologist.

    ABCD2 Is an Acronym

    • The acronym ABCD2 stands for age, blood pressure, clinical symptoms, duration of symptoms and diabetes. When the doctor calculates the patient's risk of impending stroke, he analyzes each of those five factors and assigns a number between 0 and 2 to each one. A total score of 0 to 3 is considered low risk. A score of 4 to 5 is considered moderate risk. A score of 6 to 7 is considered high risk.

    Individual Factor Scores

    • A patient's age of 60 or more is scored 1. Systolic blood pressure of 140 or higher and/or diastolic pressure of 90 or higher is scored 1. The clinical symptoms score is 1 for speech impairment or 2 for weakness on one side of the body. A duration of nine minutes or less is scored 0, a duration of 10 to 59 minutes is scored 1, a duration of an hour or longer is scored 2. If the patient has diabetes, that adds 1 point.

    Accuracy

    • Studies of the accuracy of ABCD2 in predicting stroke are ongoing. Emergency physician Dr. Alan Adams, on staff at Heart of the Rockies Regional Medical Center in Salida, Colorado, said, "I think it's useful within the parameters of medicine--which is never 100 percent."

    Time Is of the Essence

    • Adams said that, when a patient comes in with stroke symptoms, his first task is to control the blood pressure. "We're going to collect the clinical information about when it started, what's going on and we're going to use a stroke scale," Adams said. A CT scan will be done to check for a ruptured blood vessel in the brain. If no vessels have ruptured, anticoagulants can be given to reduce the blockage. Unless symptoms abate, the emergency staff proceeds with protocol for treating stroke: the quicker the treatment, the better the patient's chance of recovery, Adams explained. If stroke symptoms pass, TIA is the next assumption, and the ABCD2 is calculated.

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