STUDY OBJECTIVE: We evaluate, in admitted patients with transient ischemic 
attack, the accuracy of the ABCD(2) (age [A], blood pressure [B], clinical 
features [weakness/speech disturbance] [C], transient ischemic attack duration 
[D], and diabetes history [D]) score in predicting ischemic stroke within 7 
days.
METHODS: At 16 North Carolina hospitals, we enrolled a prospective, 
nonconsecutive sample of admitted patients with transient ischemic attack and 
with no stroke history, presenting within 24 hours of transient ischemic attack 
symptom onset. We conducted a medical record review to determine ischemic stroke 
outcomes within 7 days. According to a modified Rankin Scale Score, strokes were 
classified as disabling (>2) or nondisabling (< or =2).
RESULTS: During a 35-month period, we enrolled 1,667 patients, of whom 373 (23%) 
received a diagnosis of an ischemic stroke within 7 days. Eighteen percent 
(69/373) of all strokes were disabling. We were unable to calculate an ABCD(2) 
score in 613 patients (37%); however, our imputed analysis indicated this did 
not significantly alter results. The discriminatory power of the ABCD(2) score 
was modest for ischemic stroke in 7 days (c statistic 0.59), and fair for 
disabling ischemic stroke within 7 days (c statistic 0.71). Patients 
characterized as low risk according to ABCD(2) score (< or =3) were at low risk 
for experiencing a disabling stroke within 7 days, with a negative likelihood 
ratio of 0.16 (95% confidence interval [CI] 0.04 to 0.64) with missing values 
excluded and 0.34 (95% CI 0.15 to 0.76) when missing values were imputed.
CONCLUSION: Our analysis suggests the best application of the ABCD(2) score may 
be to identify patients at low risk for an early disabling ischemic stroke. 
Further study of the ability to determine an ABCD(2) score in all patients is 
needed, along with validation in a large, consecutive population of patients 
with transient ischemic attack.