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A UK study has established a risk score to allow GPs to identify patients who need emergency inpatient care after suffering a mini-stroke.

Researchers assessed the risk associated with a range of signs and symptoms to identify patients at high risk of stroke within seven days of a transient ischaemic attack.

Their new six-point scale, named the ABCD score, has been described as 'practice-changing' by GPs and will allow high-risk patients to be selected for immediate inpatient treatment.

Study leader Professor Peter Rothwell, professor of clinical neurology in the stroke prevention research unit at the University of Oxford, said the 'vast majority' of early strokes after a TIA occurred in patients who were waiting for an outpatient appointment.

'We found people with a score of six have a stroke risk of 30 per cent in the next seven days. My view is we should be admitting that group for emergency inpatient care.'

Researchers developed the 'highly predictive' ABCD score after assessing 209 patients with probable or definite TIA enrolled in the Oxford Community Stroke Project.

Scores were assigned for age, blood pressure, clinical features and duration of symptoms (see box).

The study, published online in The Lancet this week, found patients with a score of six had a 31.4 per cent risk of a stroke in the seven days after a TIA.

A score of five predicted a 12.1 per cent risk. All the patients in the study who had a stroke in the seven days after a TIA had a score of four or more.

Professor Rothwell added: 'Patients with high scores should be treated as an emergency. TIA can present as a myriad of symptoms but with this score GPs don't have to worry so much about diagnosis but can concentrate on symptoms.'

Dr Stewart Findlay, treasurer of the Primary Care Cardiovascular Society and PEC chair for Durham Dales PCT, said: 'This would be a very useful tool, particularly as we move into practice-based commissioning, and there will be pressure on us to make best use of hospital admissions.'

By Emma Wilkinson

Scoring risk

A

Aged over 60 1

B

Systolic blood pressure > 140mmHg and/or

diastolic =90mmHg 1

C

Clinical features

Unilateral weakness 2

Speech disturbance without weakness 1

Other 0

D

Duration of symptoms in minutes

=60 2

10-59 1

<10>

Score of six or more indicates need for emergency inpatient care

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