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Abstract Details

Do Retinal Microvascular Changes Improve TIA Risk Stratification Scores? ABCD2 vs. ABCDEye in the FOTO-TIA Study
Cerebrovascular Disease and Interventional Neurology
P9 - Poster Session 9 (5:30 PM-6:30 PM)
13-007
The ABCD2 score is widely used for transient ischemic attack (TIA) risk stratification in the emergency department (ED).
We aimed to determine the effect of adding retinal microvascular findings and diffusion weighted imaging (DWI) positivity to the ABCD2 score for predicting the probability of a cerebrovascular event (CVE).

In a cohort of adult patients with a NIH Stroke Scale ≤ 3 admitted to EDs’ observation units for an accelerated diagnostic protocol for suspected TIA or stroke, we prospectively recorded clinical and imaging results. Non-mydriatic fundus photographs were systematically obtained in the ED and reviewed for retinal microvascular findings (retinal hemorrhages, cotton wool spots, retinal emboli or occlusions, hard exudates, or microaneurysms). A stroke neurologist rated the probability each patient’s presentation (masked to fundus photography) represented a CVE on a visual analogue scale. Linear regression modeling was used for analysis.

We included 395 patients (median age: 57 years (interquartile range [IQR]: 50–66); 34 (9%) retinal microvascular findings present).  Comparing regression coefficients suggested replacing diabetes in the ABCD2 with microvascular findings, but when using the original ABCD2 point cutoffs (e.g., age ≥ 60: 1 point), both models had poor calibration (predicted vs. neurologist-determined probability of TIA). By incorporating DWI positivity and either microvascular findings or diabetes and by using the full regression coefficients, excellent calibration was achieved (bootstrap bias corrected mean absolute error ~1%) and slightly favored microvascular findings over diabetes.

Although we have reported that retinal microvascular findings among patients with suspected TIA in the ED are an independent factor differentiating TIA and stroke from mimics, incorporating them into ABCD2 does not markedly improve rule performance. However, slight improvements obtained by switching from diabetes to retinal microvascular findings suggests presence of diabetic ophthalmic microvascular disease better predicts CVE than simply the presence of diabetes.

Authors/Disclosures
Beau Benjamin Bruce, MD, FAAN (Centers for Disease Control & Prevention)
PRESENTER
Dr. Bruce has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Bayer.
Fadi B. Nahab, MD Dr. Nahab has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Consultation. Dr. Nahab has received intellectual property interests from a discovery or technology relating to health care.
Jeffery Siegelman The institution of Jeffery Siegelman has received research support from encrhoma.
Nicolas Antonio Bianchi, MD (Emory University) Dr. Bianchi has received personal compensation in the range of $0-$499 for serving as a Consultant for Innovation Hub Enterprises, LLC. The institution of Dr. Bianchi has received research support from Emory Medical Care Foundation.
Mung Yan Lin Mung Yan Lin has nothing to disclose.
Benjamin Meyer Mr. Meyer has nothing to disclose.
Michael Ross (Emory School of Medicine) Michael Ross has nothing to disclose.
David W. Wright No disclosure on file
Nancy J. Newman, MD, FAAN (Emory University School of Medicine) Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophoenix. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Avidity. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Neurophth. The institution of Dr. Newman has received research support from GenSight. The institution of Dr. Newman has received research support from Chiesi/Santhera. The institution of Dr. Newman has received research support from NINDS/NIH. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care.
Valerie Biousse, MD Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $0-$499 for serving as a Consultant for Neurophoenix. The institution of Dr. Biousse has received research support from NIH. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.