加拿大渥太华大学Jeffrey J Perry团队比较了加拿大TIA评分与ABCD2和ABCD2i前瞻性验证短暂性脑缺血发作后中风的效果。2021年2月4日，该成果发表在《英国医学杂志》上。
Title: Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study
Author: Jeffrey J Perry, Marco L A Sivilotti, Marcel émond, Ian G Stiell, Grant Stotts, Jacques Lee, Andrew Worster, Judy Morris, Ka Wai Cheung, Albert Y Jin, Wieslaw J Oczkowski, Demetrios J Sahlas, Heather E Murray, Ariane Mackey, Steve Verreault, Marie-Christine Camden, Samuel Yip, Philip Teal, David J Gladstone, Mark I Boulos, Nicolas Chagnon, Elizabeth Shouldice, Clare Atzema, Tarik Slaoui, Jeanne Teitlebaum, Kasim Abdulaziz, Marie-Joe Nemnom, George A Wells, Mukul Sharma
Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack.
Design Prospective cohort study.
Setting 13 Canadian emergency departments over five years.
Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke.
Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit.
Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days.
Conclusion The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.