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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn. Risk of stroke following transient ischaemic attack: The ABCD 2 CPR Rose Galvin, Colm Geraghty , Nicola Motterlini, Borislav D. Dimitrov, Tom Fahey. Outline. Background ABCD 2 CPR Results & quality assessment

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Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

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  1. Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn Risk of stroke following transient ischaemic attack: The ABCD2 CPR Rose Galvin, ColmGeraghty, Nicola Motterlini, Borislav D. Dimitrov, Tom Fahey

  2. Outline • Background • ABCD2 CPR • Results & quality assessment • Discussion

  3. Background • Risk of stroke after TIA is significant • Burden of stroke • Significant challenge to clinicians to identify those at greatest risk • Face Arm Speech Time (FAST)

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  5. ABCD2Clinical Prediction Rule Age (≥60 years) Blood pressure (SBP ≥140or DBP ≥90) Clinical features (unilateral weakness and speech impairment) Duration of symptoms (≥60 minutes and ≥ 10-59 minutes) Diabetes 0-3 6-7 4-5 Low Risk Moderate Risk High Risk Management in community Specialist assessment within 7 days Urgent hospital admission (< 24 hours)

  6. Aim • To assess the predictive value of the ABCD2 rule in relation to • 7 & 90 day risk of stroke across the three risk strata

  7. Calibration – risk ratio Predicted Disease risk (%) Observed Low Moderate High Score risk <1 “under-prediction” =1 “accurate prediction” >1 “over-prediction” Predicted Risk ratio -> Observed

  8. Pooled analysis – 7 days Low Moderate High 12 validation studies n= 5626 Total RR(95% CI) 1.11 (0.61-2.02) 1.10 (0.75-1.62) 0.98 (0.72-2.34) I2=0% I2 =59% I2 =27% N=1933 N=2640 N=1053

  9. Pooled analysis – 90 days Low Moderate High 8 validation studies n=4897 Total RR(95% CI) 1.48 (0.86-2.55) 2.10 (1.25-3.53) 1.83 (0.92-3.65) I2=27% I2 =78% I2 =83% N=1660 N=2214 N=1033

  10. Quality assessment • To assess the methodological quality of the validation studies • 2 independent raters • McGinn quality checklist • internal validity • external validity

  11. Quality of ABCD2 validation studies

  12. Discussion • ABCD2 is a useful CPR, particularly in relation to 7 day risk of stroke • Variation in the study setting and design needs to be considered • International consensus regarding low and high risk patients

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