BACKGROUND: Several clinical scales have been developed for predicting stroke 
recurrence. These clinical scores could be extremely useful to guide triage 
decisions. Our goal was to compare the very early predictive accuracy of the 
most relevant clinical scores [age, blood pressure, clinical features and 
duration of symptoms (ABCD) score, ABCD and diabetes (ABCD2) score, ABCD and 
brain infarction on imaging score, ABCD2 and brain infarction on imaging score, 
ABCD and prior TIA within 1 week of the index event (ABCD3) score, California 
Risk Score, Essen Stroke Risk Score and Stroke Prognosis Instrument II] in 
consecutive transient ischemic attack (TIA) patients.
METHODS: Between April 2008 and December 2009, we included 1,255 consecutive TIA 
patients from 30 Spanish stroke centers (PROMAPA study). A neurologist treated 
all patients within the first 48 h after symptom onset. The duration and 
typology of clinical symptoms, vascular risk factors and etiological work-ups 
were prospectively recorded in a case report form in order to calculate 
established prognostic scores. We determined the early short-term risk of stroke 
(at 7 and 90 days). To evaluate the performance of each model, we calculated the 
area under the receiver operating characteristic curve. Cox proportional hazards 
multivariate analyses determining independent predictors of stroke recurrence 
using the different components of all clinical scores were calculated.
RESULTS: We calculated clinical scales for 1,137 patients (90.6%). Seven-day and 
90-day stroke risks were 2.6 and 3.8%, respectively. Large-artery 
atherosclerosis (LAA) was observed in 190 patients (16.7%). We could confirm the 
predictive value of the ABCD3 score for stroke recurrence at the 7-day follow-up 
[0.66, 95% confidence interval (CI) 0.54-0.77] and 90-day follow-up (0.61, 95% 
CI 0.52-0.70), which improved when we added vascular imaging information and 
derived ABCD3V scores by assigning 2 points for at least 50% symptomatic 
stenosis on carotid or intracranial imaging (0.69, 95% CI 0.57-0.81, and 0.63, 
95% CI 0.51-0.69, respectively). When we evaluated each component of all 
clinical scores using Cox regression analyses, we observed that prior TIA and 
LAA were independent predictors of stroke recurrence at the 7-day follow-up 
[hazard ratio (HR) 3.97, 95% CI 1.91-8.26, p < 0.001, and HR 3.11, 95% CI 
1.47-6.58, p = 0.003, respectively] and 90-day follow-up (HR 2.35, 95% CI 
1.28-4.31, p = 0.006, and HR 2.20, 95% CI 1.15-4.21, p = 0.018, respectively).
CONCLUSION: All published scores that do not take into account vascular imaging 
or prior TIA when identifying stroke risk after TIA failed to predict risk when 
applied by neurologists. Clinical scores were not able to replace extensive 
emergent diagnostic evaluations such as vascular imaging, and they should take 
into account unstable patients with recent prior transient episodes.