For healthcare professionals
ABCD3-I score
The ABCD3-I score adds dual TIA and two imaging findings (ipsilateral carotid stenosis and an acute lesion on diffusion-weighted MRI) to the ABCD2 items, for a total of 0 to 13 points after a transient ischemic attack (TIA). This tool is written for clinicians. It is not a self-check and not a diagnosis.
The items
Items and points as printed by Mayer and colleagues and by Ildstad and colleagues (Mayer 2018) (Ildstad 2021). Nothing you enter leaves this page.
What you will see
The ABCD3-I score from 0 to 13, its group and the stroke rates one cohort reported for that group.
Educational only, not medical advice. A score supports clinical judgment; it does not decide treatment on its own.
Source
Merwick A et al., Lancet Neurol 2010 (the original score, cited only). Items and points as printed in Mayer L et al., J Neurol 2018 (CC BY) and Ildstad F et al., Stroke Res Treat 2021 (CC BY); group stroke rates from Ildstad 2021.
Validated in
Studied in 5,237 patients with TIA or minor stroke from the Austrian Stroke Unit Registry, with data from 37 stroke units (Mayer 2018), and in 305 patients with TIA from eight hospitals in Central Norway, 2012 to 2014 (Ildstad 2021). The derivation and validation cohorts of the original score are described in Merwick 2010 (cited only).
Limits
For clinicians in secondary care, once a TIA has been diagnosed and brain and carotid imaging are available. Not a symptom checker and not a reason to delay care: a low score does not mean no risk. The rates on this page come from one low-risk cohort with few strokes and wide confidence intervals, and may not apply elsewhere.
The points
| Item | Points |
|---|---|
| Age 60 years or older | 1 |
| Blood pressure 140/90 mmHg or higher | 1 |
| Clinical features: unilateral weakness | 2 |
| Clinical features: speech impairment without weakness | 1 |
| Duration 60 minutes or longer | 2 |
| Duration 10 to 59 minutes | 1 |
| Diabetes | 1 |
| Dual TIA (at least one other TIA in the preceding 7 days) | 2 |
| Ipsilateral internal carotid artery stenosis of 50% or more | 2 |
| Acute diffusion-weighted imaging hyperintensity | 2 |
Points as printed in Table 1 of both papers, total range 0 to 13 (Mayer 2018) (Ildstad 2021). The first five rows are the ABCD2 items. The score was first published by Merwick and colleagues (Merwick 2010). In the Norwegian study, a positive DWI meant one or more areas of high signal read as acute ischemic lesions, and carotid stenosis meant 50% or more narrowing of the internal carotid artery that could explain the symptoms (Ildstad 2021).
What studies found
Ildstad and colleagues followed 305 patients with TIA in Central Norway. Overall, 1.0% had a stroke within 1 week, 3.3% within 3 months and 5.2% within 1 year (Ildstad 2021). Rates by ABCD3-I group, as printed in their Table 3:
| ABCD3-I group | Patients, n (%) | Stroke within 1 week | Within 3 months | Within 1 year |
|---|---|---|---|---|
| 0 to 3 | 72 (23.6) | 0 | 0 | 1 (2.1%) |
| 4 to 7 | 193 (63.3) | 2 (1.0%) | 7 (3.6%) | 11 (5.7%) |
| 8 to 13 | 40 (13.1) | 1 (2.5%) | 3 (7.5%) | 4 (10.0%) |
Figures as printed in the source; the 1-year value for 0 to 3 points reads 1 (2.1%).
The area under the curve (AUC) for the ABCD3-I score was 0.72 (95% CI 0.54 to 0.89) at 1 week, 0.66 (0.53 to 0.80) at 3 months and 0.68 (0.56 to 0.79) at 1 year, against 0.55, 0.55 and 0.63 for the ABCD2 score (Ildstad 2021). The authors concluded that the ABCD3-I score had limited value for short-term prediction in this low-risk population (Ildstad 2021).
In the Austrian Stroke Unit Registry, among 5,237 patients with TIA or minor stroke, the AUC was 0.664 (0.618 to 0.709) for early stroke during the stroke unit stay and 0.646 (0.592 to 0.700) for stroke within 3 months. The risk of early and 3-month stroke rose with the score whether TIA was defined by symptom duration or by imaging (Mayer 2018).
Where the score fits
The ABCD3-I score was developed for use in secondary care and includes information from initial diagnostic investigations. Ildstad and colleagues note it was not intended for prehospital use, because DWI and carotid imaging are generally not available to community-based clinicians who make referrals (Ildstad 2021).
Related tools
For the five-item score without imaging, see the ABCD2 score. To grade stroke severity, see the NIH Stroke Scale (NIHSS). For a 1-year recurrence score, see the Essen Stroke Risk Score. Other bedside scores are listed under For healthcare professionals.
Sources
- Merwick A, Albers GW, Amarenco P, et al. Addition of brain and carotid imaging to the ABCD2 score to identify patients at early risk of stroke after transient ischaemic attack: a multicentre observational study. Lancet Neurol. 2010;9(11):1060-1069. doi:10.1016/S1474-4422(10)70240-4. PMID 20934388. Original score (cited only). doi.org/10.1016/S1474-4422(10)70240-4
- Mayer L, Ferrari J, Krebs S, et al. ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke. J Neurol. 2018;265(3):530-534. doi:10.1007/s00415-017-8720-8. PMID 29327286. Open access (CC BY). Table 1 (ABCD3-I items and points, range 0-13); Table 2 (5,237 patients, AUCs). pmc.ncbi.nlm.nih.gov/articles/PMC5834555/
- Ildstad F, Ellekjaer H, Wethal T, Lydersen S, Fjaertoft H, Indredavik B. ABCD3-I and ABCD2 Scores in a TIA Population with Low Stroke Risk. Stroke Res Treat. 2021;2021:8845898. doi:10.1155/2021/8845898. PMID 33708373. Open access (CC BY). Table 1 (items and points); Table 3 (stroke rates by ABCD3-I group 0-3, 4-7, 8-13; AUCs); Methods and Discussion. pmc.ncbi.nlm.nih.gov/articles/PMC7932764/
- National Institute of Neurological Disorders and Stroke (NIH). Transient Ischemic Attack (TIA). www.ninds.nih.gov/health-information/disorders/transient-ischemic-attack
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-04. Spotted an error? See About.