VALIDATION OF AGE, BLOOD PRESSURE, CLINICAL FEATURES, DURATION, AND DIABETES SCORE AS IDENTIFYING INDIVIDUALS AT HIGH EARLY RISK OF STROKE AFTER A TRANSIENT ISCHEMIC ATTACK AT JINNAH POSTGRADUATE MEDICAL CENTRE, KARACHI

Abstract

Background: Transient ischemic attack (TIA) is a major predictor of subsequent stroke, with the highest risk occurring in the early post-attack period. The ABCD² score is a widely used clinical tool for stratifying this risk; however, local validation is required to determine its predictive accuracy in South Asian populations. Objective: To validate the ABCD² score in identifying individuals at high early risk of stroke following a transient ischemic attack at Jinnah Postgraduate Medical Centre (JPMC), Karachi. Study Design: Cross-sectional study. Setting: Ward 28, Department of Neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. Duration of Study: 20 January 2025 to 20 June 2025. Methods: Following ethical approval, 93 patients aged 18–70 years of both genders presenting with TIA were enrolled using non-probability consecutive sampling. Patients with a history of stroke, head trauma, atrial fibrillation, or intracerebral hemorrhage were excluded. ABCD² scores were calculated at presentation, and patients were followed for the occurrence of stroke. Data were analyzed using descriptive statistics, and associations between clinical variables and stroke outcomes were assessed using chi-square tests and t-tests, with p < 0.05 considered statistically significant. Results: The mean ABCD² score was 2.9 ± 2.1. Stroke occurred in 50 patients (54%). Age was significantly associated with stroke (p=0.018), with higher occurrence among patients >30 years (37 vs. 13 cases). Hypertension (p=0.004), diabetes mellitus (p<0.0001), myocardial infarction (p<0.0001), angioplasty (p<0.0001), CABG (p<0.0001), and angina (p=0.036) were significantly linked to stroke occurrence. Gender (p = 0.229), hyperlipidemia (p = 0.099), and smoking (p = 0.673) showed no significant association. Conclusion: The ABCD² score demonstrated predictive utility for early stroke risk among TIA patients in our cohort. However, significant associations with comorbidities such as hypertension, diabetes, and ischemic heart disease suggest that region-specific, comprehensive risk assessment models may provide superior predictive value for South Asian populations.