BACKGROUND: Modifications to the age, blood pressure, clinical symptoms, 
duration of symptoms, and diabetes (ABCD2) score, which incorporate history of 
hypertension and acute hyperglycemia in addition to acute blood pressure (BP) 
elevation and history of diabetes, have been proposed to increase the predictive 
value of the score. In addition, the timing of acute BP measurement may be 
important in the emergency department (ED) setting, given the phenomenon of "ED 
triage hypertension".
METHODS: The standard ABCD2 score was compared to modified scores incorporating 
various combinations of acute BP elevation or hyperglycemia, history of 
hypertension or diabetes, and subsequent versus initial ED BP measurements. The 
number of patients reclassified into an alternate risk category 
(low/moderate/high) with different schemes was determined. Predictive value 
using the composite outcome of stroke, death, or high-risk transient ischemic 
attack mechanism was assessed using c statistics.
RESULTS: Modified ABCD2 scores resulted in few patients shifting risk categories 
(between 2% and 10% for six alternate schemes), and did not improve the 
performance of the ABCD2 score (c-statistics, 0.61-0.65, compared to 0.63 for 
the standard score). ED triage hypertension was frequent (mean systolic blood 
pressure [SBP]/diastolic blood pressure [DBP] decrease of 8/9 mm Hg on 
subsequent measurement; P < .001), but the use of second BP did not reclassify 
many patients (10%) nor did it improve score performance (c-statistic, 0.61).
CONCLUSIONS: Modifications of the ABCD2 score changed the risk category for few 
patients and did not improve the overall predictive value of the score.