East and North Hertfordshire NHS Trust

TIA Assessment and Referral

  • Higher risk patients ABCD2 score of 4 or more need immediate same day referral so they can be seen within 24 hours. The process is shown below.
  • Lower risk patients ABCD2 score < 4 also need immediate referral and will be seen within 7 days
    • Patients with a suspected TIA (that is, they have no residual symptoms or signs at the time of assessment [within 24 hours]) should be assessed using the ABCD2 score. The ABCD2 algorithm to identify patients at high risk of stroke following a TIA is calculated using

  • A - age (>=60 years, 1 point)
  • B - blood pressure at presentation (>=140/90 mmHg, 1 point)
  • C - clinical features (unilateral weakness, 2 points; speech disturbance without weakness, 1 point)
  • D - Duration of symptoms (>= 60 minutes, 2 points; 10-59 minutes, 1 point)
  • D - Diabetes (1 point)

    total scores range from 0 (low risk) to 7 (high risk).

    Download TIA Referral form here

    Suspected TIA with an ABCD2 score of 4 or above should have

  • Aspirin (300 mg daily) started immediately
  • Immediately fax a referral including ABCD2 score to 01438 781754
  • The internal hospital fax number is Ext 5985
  • Include the ABCD2 score in the referral
  • Give the patient a copy of the referral
  • Ask the patient to attend Lister level 6AS the next day promptly at 10.30 am
  • Advise patients not to drive for 28 days and so not to drive to the appointment.
  • Advise patient that if symptoms return they must seek urgent help.
  • Stress the importance of attending.

    Those with ABCD2 score less than 4

  • Consider starting aspirin 300 mg od
  • QE2 catchment area
  • Lister catchment area