BACKGROUND AND PURPOSE: The risk of stroke after a transient ischaemic attack 
(TIA) can be predicted by scores incorporating age, blood pressure, clinical 
features, duration (ABCD-score), and diabetes (ABCD2-score). However, some 
patients have strokes despite a low predicted risk according to these scores. We 
designed the ABCDE+ score by adding the variables 'etiology' and ischaemic 
lesion visible on diffusion-weighted imaging (DWI) -'DWI-positivity'- to the 
ABCD-score. We hypothesized that this refinement increases the predictability of 
recurrent ischaemic events.
METHODS: We performed a prospective cohort study amongst all consecutive TIA 
patients in a university hospital emergency department. Area under the computed 
receiver-operating curves (AUCs) were used to compare the predictive values of 
the scores with regard to the outcome stroke or recurrent TIA within 90 days.
RESULTS: Amongst 248 patients, 33 (13.3%, 95%-CI 9.3-18.2%) had a stroke (n = 
13) or a recurrent TIA (n = 20). Patients with recurrent ischaemic events more 
often had large-artery atherosclerosis as the cause for TIA (46% vs. 14%, P < 
0.001) and positive DWI (61% vs. 35%; P = 0.01) compared with patients without 
recurrent events. Patients with and those without events did not differ with 
regard to age, clinical symptoms, duration, blood pressure, risk factors, and 
stroke preventive treatment. The comparison of AUCs [95%CI] showed superiority 
of the ABCDE+ score (0.67[0.55-0.75]) compared to the ABCD(2) -score 
(0.48[0.37-0.58]; P = 0.04) and a trend toward superiority compared to the 
ABCD-score (0.50[0.40-0.61]; P = 0.07).
CONCLUSION: In TIA patients, the addition of the variables 'etiology' and 
'DWI-positivity' to the ABCD-score seems to enhance the predictability of 
subsequent cerebral ischaemic events.