London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 735 738 Acute cerebrovascular events (ACE): TIA and minor strokes Frequent inaccuracies in ABCD2 scores by non-stroke specialists referring to a daily Rapid Access Stroke Prevention service D. Bradley1, S. Cronin2, J.A. Kinsella3, W.O. Tobin4, C. Mahon5, M. O’Brien6, R. Lonergan7, M.T. Cooney8, S. Kennelly9, D.R. Collins10, D. O’Neill11, T. Coughlan12, S. Smyth13, D.J.H. McCabe14 Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND1, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND2, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND3, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND4, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND5, Adelaide and Meath Hospital, Dublin incorpo-rating the National Children’s Hospital, Dublin, IRELAND6, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND7, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND8, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND9, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRE-LAND10, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND11, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND12, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND13, Adelaide and Meath Hospital, Dublin incorporating the National Children’s Hospital, Dublin, IRELAND14 The ‘accuracy’ of Age, Blood pressure, Clinical features, Duration and Diabetes (ABCD2) scoring by non-stroke specialists referring patients to a daily Rapid Access Stroke Prevention (RASP) ser-vice is unclear, as is the accuracy of ABCD2 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. ABCD2 scores from referring physicians were compared with scores by experienced stroke special-ists and neurology/geriatric medicine residents at a daily RASP clinic; inter-observer was examined. 101 referrals were analysed (mean age 60.0 years, 58% male). The median interval between refer-ral and clinic assessment was 1 day. 52/101 (52%) of referrals were ‘non-TIAs’; 45/52 (86%) ‘TIA mimics’ and 7/52 (14%) completed strokes. There was only ‘fair’ agreement in total ABCD2 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. ABCD2 scoring by referring doctors was frequently inaccurate, with a tendency to underestimate stroke risk. These findings emphasize the importance of urgent specialist assessment of suspected TIA patients and that ABCD2 scores by non-stroke specialists cannot be relied upon in isolation to risk-stratify patients. Inter-observer agreement in ABCD2 scoring was ‘excellent’ between residents and stroke specialists, indicating short-term training may improve accuracy. 739 Acute cerebrovascular events (ACE): TIA and minor strokes Should MRI or CT be used for the TIA clinic? J. Ganesalingam1, I.E. Jenkins2 Department of Neurology. Imperial College Healthcare NHS Trust, London, UNITED KING-DOM1, Department of Neurology. Imperial College Healthcare NHS Trust, London, UNITED KINGDOM2 BACKGROUND: The Royal College of Physicians and National institute of Clinical Excellence have recommended that MRI should be the modality of choice for cerebral imaging in TIA patients. However, implementation of this is often difficult because there are many competing demands for MRI slots in most acute Trusts. Therefore, it is important to know if MRI rather than CT im-proves clinical management in TIA patients. AIMS: To determine whether acute MR imaging in TIA changes clinical management. METHODS: This was a retrospective case-notes review of 65 consecutive patients seen by one neurology trainee (with consultant review), in a neurovascular service where CT has been the primary imaging modality. We recorded the preliminary clinical di-agnosis, details of investigations performed acutely (CT brain and/or carotid Doppler ultrasound) and whether or not they had a subsequent MRI Brain scan. We also recorded the number followed up as outpatients and the final diagnosis. RESULTS: Of the 65 cases seen, 55% were classified initially as stroke mimics. Of the 29 cases that were classified as TIA, all had CT scans and carotid dopplers acutely. 12 had MRI scans subsequently, and 14 were followed up several weeks later. Of the 36 cases classified as stroke mimics, 27 had CT scans immediately and 31 had carotid dopplers. 6 subsequently had MRI scans and 14 were followed up in clinic. Only 3 patients (2 initially classi-fied as TIA, 1 as a mimic) had their diagnosis revised on the basis of the MRI. 28% of the 65 cases had both CT and MRI. DISCUSSION: In TIA clinics, acute MRI Imaging could reduce costs from duplicate imaging, but is a more expensive modality than CT. Our study suggests that MRI Brain changes the diagnosis in a relatively small percentage of cases. A good history and examination re-mains paramount in the assessment of patients presenting to the TIA clinic, particularly when more than 50% of cases referred are TIA/stroke mimics.
Karger_ESC London_2013
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