Review highlights importance of examining totality of evidence prior to use of CPRs in clinical practice

Research carried out by the HRB Centre for Primary Care Research, based in the Royal College of Surgeons in Ireland (RCSI), recently published in the journal Family Practice aims to help patients that have suffered a transient ischaemic attack (TIA), otherwise known as a "mini-stroke" by assessing their risk of subsequent stroke. 

Clinical Prediction Rule's (CPR's) are used regularly by doctors to help identify the best combination of medical signs and symptoms in order to predict the likelihood of a patient experiencing a specific disorder. The research carried out by the HRB Centre was a systematic review of the ABCD2 CPR which doctors use to identify individuals who are most at risk of having a stroke after experiencing a TIA.  The research found that the ABCD2 rule can predict the likelihood of a patient experiencing a stroke between 7 and 90 days after they have experienced a TIA with a very high accuracy.

The ABCD2 rule is based on age, hypertension, clinical features, such as weakness or speech impairment, duration of symptoms and presence of diabetes.  Based on the number of symptoms present, a patient is divided into low, moderate or high risk of stroke.

Commenting on the review, Prof Tom Fahey, Principal Investigator at the HRB Centre said, 'This review highlights the importance of examining the totality of evidence prior to the use of CPRs in clinical practice. The HRB Centre for Primary Care Research is in the process of developing an international register of clinical prediction rules relevant to primary care and this review will contribute to the international register.  Upon completion, the register will ultimately assist with the knowledge transfer of evidence based medicine in clinical practice, at the point of patient care'. This web-based register will be made publicly available through the Cochrane Primary Health Care Field (http://www.cochraneprimarycare.org/) in 2012.