Canadian TIA Score Versus ABCD2 Score in Risk Stratification of Transient Ischemic Attack (TIA)

This study aims to evaluate the superiority of a clinical score (Canadian TIA score) compared to the currently more widely used score in clinical practice (ABCD2 score) in stratifying the risk of stroke or carotid revascularization following a transient ischemic attack at 7 days, and to assess its superiority at 90 days in a European population.

Patients with transient ischemic attack are at high risk of developing a subsequent stroke, especially in the short term. Identifying patients at greater risk would allow for optimized management to provide aggressive treatment within the first days following the event. All patients attending the Emergency Medicine department of this hospital will be enrolled over a consecutive 24-month period. Approximately 800 participants are expected to take part in this study.

At the time of admission to the Emergency Medicine department, the various prognostic scores relevant to the study will be completed, taking about one minute. At 7 and 90 days from the date of admission, the patient will be contacted by phone and will be administered a validated questionnaire (Questionnaire for Verifying Stroke-Free Status), which will take approximately one minute.

Study Overview

• Status: Recruiting
• Conditions: Transient Ischemic Attack (TIA)

Detailed Description

Rationale: Patients with transient ischemic attack (TIA) are at high risk of developing a subsequent stroke, especially in the short term. Identifying patients at greater risk allows for optimized management to provide aggressive treatment in the early days following the event, a strategy that is not feasible for the entire patient cohort. Over time, several prognostic scores have been studied, among which the most widely used is the ABCD2 score; however, this score has not proven particularly reliable in distinguishing between low-risk and high-risk patients in prospective validation studies. More recently, the Canadian TIA score has been proposed, but it has only been validated in the Canadian population.

Study design: Patients with TIA attending the Emergency Department of IRCCS AOU di Bologna Policlinico di S.Orsola will be included, and they will be admitted to the Emergency Medicine department according to the currently implemented protocol. At the time of admission, the various prognostic scores relevant to the study (Canadian TIA score, ABCD2, and ABCD3) will be completed by the physician during the standard medical assessment. Patients will also be contacted by phone at 7 and 90 days.

The study is observational and non-interventional. Patients will be treated according to standard clinical practice based on the physician's judgment and the information provided in the Technical Data Sheet of each individual product for any concomitant therapies administered according to clinical practice.

Objectives: The study aims to evaluate the superiority of the Canadian TIA score compared to the ABCD2 score in stratifying the risk of stroke or carotid revascularization following TIA at 7 days, and to assess its superiority at 90 days in a European population. Additionally, secondary objectives will include evaluating the superiority of the Canadian score over the ABCD2 score in stratifying the risk of major cerebrovascular events following TIA at 7 and 90 days across different subpopulations (age < or ≥ 65 years; TIA etiology according to the TOAST classification) and assessing the superiority of the Canadian score compared to the ABCD2 score in stratifying the risk of major cerebrovascular events following TIA at both 7 and 90 days.

Outcomes: The primary outcome will be composite: the occurrence of stroke or carotid revascularization (endarterectomy or stenting) within 7 days of emergency department admission. Stroke will be defined as the sudden onset of neurological symptoms that persist for more than 24 hours or until death, in the absence of apparent non-vascular causes. A secondary outcome will be the occurrence of a stroke within 7 days of emergency department admission, regardless of carotid revascularization, and at 90 days. Outcomes will be assessed through electronic medical records and emergency department reports. All patients will be contacted at 7 and 90 days to evaluate any subsequent TIA or stroke using the validated questionnaire "Questionnaire for Verifying Stroke-Free Status."

Population: Adult patients with TIA attending the Emergency Department of IRCCS AOU di Bologna Policlinico di S.Orsola will be included and admitted to the Emergency Medicine department according to the currently implemented protocol. Recruitment is expected to last 24 months, followed by 12 months for data processing.

Statistical Analysis: The characteristics of patients enrolled in the study will be summarized in tables. Descriptive statistical analyses will be conducted to describe the collected data: continuous variables will be described using means, standard deviations, minimum and maximum values, and percentiles; discrete or nominal variables will be summarized using relative frequency percentages. The classification performance of the Canadian TIA Score will be calculated for each risk category (low, medium, and high) using interval odds ratios with 95% confidence intervals. The interval odds ratio is the multilevel extension of positive and negative odds ratios, which are applicable only when a test/risk score is dichotomized into two levels (positive vs. negative or high risk vs. low risk). We pre-specified risk thresholds (low risk <1%, medium risk 1-5%, and high risk >5%) based on literature reports. Sensitivity and specificity will be calculated for dichotomized scores for each integer value from -3 to 23. The classification of ABCD2 and ABCD3 scores will also be calculated for both primary and secondary outcomes based on their ability to classify patients as low, medium, and high risk, using cutoff points based on the same risk thresholds (low risk <1%, medium risk 1-5%, and high risk >5%). The C statistic (area under the curve) will then be compared using discrete values for each score, employing the DeLong method to verify the significance of these differences. Finally, net reclassification improvement indices will be calculated using three levels (low, medium, and high risk), comparing the Canadian TIA Score with the ABCD2 and ABCD3 scores.

• Study Type: Observational
• Enrollment (Estimated): 800

Contacts and Locations

• Study Contact: Name: Veronica Salvatore, MD; Phone Number: +39 0512144716; Email: veronica.salvatore@aosp.bo.it

Study Locations

• Italy
  • Bologna, Italy, 40138
    • Recruiting
    • IRCCS Azienda Ospedaliero-Universitaria di Bologna
    • Contact: Veronica Salvatore; Phone Number: +39 0512144716; Email: veronica.salvatore@aosp.bo.it

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All patients presenting to the emergency department with a diagnosis of TIA who are adults and have signed the informed consent.

Description

Inclusion Criteria:

• all patients presenting to the emergency department with a diagnosis of TIA
• all adult patients
• all patients who have signed the informed consent

Exclusion Criteria:

• none

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Occurrence of stroke or carotid revascularization	Occurrence of stroke or carotid revascularization (endarterectomy or stenting) within 7 days of emergency department admission. Stroke will be defined as the sudden onset of neurological symptoms that persist for more than 24 hours or until death, in the absence of apparent non-vascular causes."	From the start of recruitment to the following 7 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Occurrence of a stroke of emergency department admission, regardless of carotid revascularization	The secondary outcome will be the occurrence of a stroke within 7 days of emergency department admission, regardless of carotid revascularization, and at 90 days	From the start of recruitment to the following 90 days

Collaborators and Investigators

• Sponsor: IRCCS Azienda Ospedaliero-Universitaria di Bologna
• Investigators: Principal Investigator: Veronica Salvatore, MD, IRCCS Azienda Ospedaliero-Universitaria di Bologna

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2022
• Primary Completion (Estimated): August 31, 2025
• Study Completion (Estimated): August 31, 2025

Study Registration Dates

• First Submitted: December 1, 2024
• First Submitted That Met QC Criteria: December 1, 2024
• First Posted (Estimated): December 5, 2024

Study Record Updates

• Last Update Posted (Estimated): December 5, 2024
• Last Update Submitted That Met QC Criteria: December 1, 2024
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Vascular Diseases; Cardiovascular Diseases; Pathologic Processes; Brain Ischemia; Ischemic Attack, Transient; Ischemia
• Other Study ID Numbers: PS-22-02

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No