ABCD² Score for TIA
Predicts 2-day stroke risk following a transient ischaemic attack
How to use & interpret
The ABCD² score (Age, Blood pressure, Clinical features, Duration, Diabetes) was designed to estimate short-term stroke risk after a TIA. Importantly, current NICE guidance no longer recommends using ABCD² to decide who needs urgent assessment: everyone with a suspected TIA should be started on aspirin (unless contraindicated) and seen by a specialist within 24 hours.
The score may still appear in older pathways and offers a rough sense of risk, but it should not be used to delay or de-prioritise specialist review.
Score interpretation
ABCD² 0–3: 1.0% 2-day stroke risk (Johnston 2007).
→ NICE NG128: start aspirin unless contraindicated and refer for specialist assessment within 24 hours, whatever the score; vascular risk factor modification.
ABCD² 4–5: 4.1% 2-day stroke risk.
→ NICE NG128: start aspirin unless contraindicated and refer for specialist assessment within 24 hours.
ABCD² 6–7: 8.1% 2-day stroke risk.
→ NICE NG128: start aspirin unless contraindicated and refer for specialist assessment within 24 hours; consider admission; cardiology if AF suspected.
Interpretation bands for the ABCD². Apply clinical judgement and local guidance.
Frequently asked questions
Should a low ABCD² score reassure me after a TIA?
No. NICE advises urgent specialist assessment within 24 hours for all suspected TIAs regardless of ABCD². A low score must not be used to defer review.
References
- Johnston SC, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–92.
Related
Curated clinical cross-links plus same-class fallbacks.
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Edoxaban (AF Stroke Prevention / VTE) · Direct Factor Xa Inhibitor (DOAC)
- Clopidogrel (Stroke/TIA Secondary Prevention) · Antiplatelet (P2Y12 Inhibitor)
- Dabigatran (Stroke Prevention — AF) · Direct Oral Anticoagulant — Thrombin Inhibitor
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
