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Background:  The ABCD² stroke risk score is recommended in national guidelines for stratifying care in transient ischaemic attack (TIA) patients, based on its prediction of early stroke risk. We had become concerned about the score accuracy and its clinical value in modern TIA cohorts.

Methods:  We identified emergency department‐diagnosed TIA at two hospitals over 3 years (2004–2006). Cases were followed for stroke occurrence and ABCD² scores were determined from expert record review. Sensitivity, specificity and positive predictive values (PPV) of moderate–high ABCD² scores were determined.

Results:  There were 827 indexed TIA diagnoses and record review was possible in 95.4%. Admitted patients had lower 30‐day stroke risk (n= 0) than discharged patients (n= 7; 3.1%) (P < 0.0001). There was no significant difference in proportion of strokes between those with a low or moderate–high ABCD …