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ABCD² Score for TIA

Early stroke risk after a transient ischaemic attack.

For healthcare professionalsNeurologyv1.0.0

For healthcare professionals / clinical use. Not a self-diagnosis tool.

Your measurements

years
mmHg
mmHg
Clinical features
Duration of symptoms
Diabetes

Calculated on your device. Nothing is sent to a server.

Your result will appear here

Enter your measurements, then press Calculate.

Methodology

ABCD² (Johnston 2007)

Age ≥ 60 1; BP ≥ 140/90 1; unilateral weakness 2 or speech only 1; duration ≥ 60 min 2 or 10–59 min 1; diabetes 1

NICE (NG128) no longer recommends using ABCD² to decide urgency: everyone with a suspected TIA should be assessed by a stroke specialist within 24 hours.

Who it is for
Adults after a suspected TIA.
Version
1.0.0

How this calculator works

Where the formula comes from

  • Johnston and colleagues (2007) validated the California and ABCD scores in 2,893 patients with TIA from the USA and UK and derived ABCD² from the two original derivation groups (1,916 patients) to predict 2-day stroke risk.[1]

The inputs

  • Points: age 60 or over 1, blood pressure 140/90 or more 1, unilateral weakness 2 or speech impairment without weakness 1, duration 60 minutes or more 2 or 10–59 minutes 1, and diabetes 1 (0–7).[1]
  • In the validation, 2-day stroke risk was 1.0% for scores 0–3, 4.1% for 4–5 and 8.1% for 6–7; c statistics ranged from 0.62 to 0.83.[1]

Where accuracy falls (published evidence)

  • A 2015 meta-analysis found that a cut-off of 4 or more was sensitive but not specific for recurrent stroke within 7 days, and that a score below 4 missed some patients with carotid stenosis or atrial fibrillation.[2]

What guidelines say

  • NICE (NG128) recommends against using scores such as ABCD² to assess stroke risk or decide referral urgency; people with suspected TIA should be referred for specialist assessment within 24 hours.[3]

Sources

  1. Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–292. doi:10.1016/S0140-6736(07)60150-0
  2. Wardlaw JM, Brazzelli M, Chappell FM, et al. ABCD2 score and secondary stroke prevention: meta-analysis and effect per 1,000 patients triaged. Neurology. 2015;85(4):373–380. PMID 26136519
  3. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128). London: NICE; 2019 (updated 2022). https://www.nice.org.uk/guidance/ng128

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on

Worked example: how to calculate ABCD²

Inputs

Age
65 years
Systolic blood pressure (top number)
150 mmHg
Diastolic blood pressure (bottom number)
85 mmHg
Clinical features
Unilateral weakness
Duration of symptoms
60 minutes or more
Diabetes
No

Result

ABCD²
6 of 7

6–7: high risk (about 8.1%)

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

  • Low scores do not exclude significant risk (e.g. atrial fibrillation, carotid stenosis).

References

  1. Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–292. doi:10.1016/S0140-6736(07)60150-0
  2. National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128). London: NICE; 2019 (updated 2022). https://www.nice.org.uk/guidance/ng128

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