The 'accuracy' of age, blood pressure, clinical features, duration and diabetes 
(ABCD(2)) scoring by non-stroke specialists referring patients to a daily Rapid 
Access Stroke Prevention (RASP) service is unclear, as is the accuracy of 
ABCD(2) scoring by trainee residents. In this prospective study, referrals were 
classified as 'confirmed TIAs' if the stroke specialist confirmed a clinical 
diagnosis of possible, probable or definite TIA, and 'non-TIAs' if patients had 
a TIA mimic or completed stroke. ABCD(2) scores from referring physicians were 
compared with scores by experienced stroke specialists and neurology/geriatric 
medicine residents at a daily RASP clinic; inter-observer agreement was 
examined. Data from 101 referrals were analysed (mean age=60.0years, 58% male). 
The median interval between referral and clinic assessment was 1day. Of 101 
referrals, 52 (52%) were 'non-TIAs': 45 (86%) of 52 were 'TIA mimics' and 7 
(14%) of 52 were completed strokes. There was only 'fair' agreement in total 
ABCD(2) scoring between referring physicians and stroke specialists (κ=0.37). 
Agreement was 'excellent' between residents and stroke specialists (κ=0.91). 
Twenty of 29 patients scored as 'moderate to high risk' (score 4-6) by stroke 
specialists were scored 'low risk' (score 0-3) by referring physicians. ABCD(2) 
scoring by referring doctors is frequently inaccurate, with a tendency to 
underestimate stroke risk. These findings emphasise the importance of urgent 
specialist assessment of suspected TIA patients, and that ABCD(2) scores by 
non-stroke specialists cannot be relied upon in isolation to risk-stratify 
patients. Inter-observer agreement in ABCD(2) scoring was 'excellent' between 
residents and stroke specialists, indicating short-term training may improve 
accuracy.