Canadian TIA Score Calculator
Calculate the Canadian TIA Score from 13 bedside variables for 7-day stroke risk after a TIA, with the risk tier, the follow-up urgency each tier implies, and how it compares with ABCD2.
Reviewed by Zaka Ahmed, MD Clinical reference · 6 min read
Canadian TIA Score Calculator
Score each item for a patient presenting with a suspected TIA. Nothing is preselected — an unanswered item is not the same as a "no", and one of these items subtracts points.
Score every item to see the risk tier and the follow-up urgency it implies.
What this tier implies
Educational tool only. The Canadian TIA Score grades urgency of follow-up; it is not a discharge rule, does not replace clinical judgment or imaging, and was validated in patients already evaluated in an emergency department. If symptoms are happening now, call emergency services. Risk estimates from Perry et al., BMJ 2021.1
Clinical notes & interpretation Scoring guidance, pitfalls, FAQs, and references
The Canadian TIA Score grades 7-day stroke risk from 13 bedside variables — and it discriminates better than ABCD2 because it counts the mechanisms ABCD2 ignores.
- → Thirteen items from history, exam, ECG, CT, and bloodwork give a total from −3 to 23.
- → Three tiers: low (≤3) about 0.5%, medium (4–8) about 2.3%, high (≥9) about 5.9% stroke risk within 7 days.
- → It grades urgency of follow-up. It is not a discharge rule, and it was validated in patients who had already been worked up in an emergency department.
ABCD2 leaves out the things that actually cause early recurrence — atrial fibrillation, carotid disease, infarction already visible on CT. The Canadian TIA Score was derived and prospectively validated to fix exactly that, and in head-to-head comparison it separated high-risk from low-risk patients better than ABCD2 did.1
At a glance · what the score changes
- ≤3 · about 0.5% stroke within 7 days. Consistent with outpatient management and primary-care follow-up — arranged deliberately. Low risk is not no risk.
- 4–8 · about 2.3%. Prompt investigations with specialist follow-up, typically within about two days.
- ≥9 · about 5.9% — roughly twelvefold the low tier. Same-visit specialist consultation and expedited workup rather than scheduled follow-up.
- A tier is not a disposition. The score grades how fast the workup should happen, not whether it happens.
- It assumes an emergency-department evaluation with ECG, CT and bloodwork has already been done — several of its highest-weighted items are otherwise missing.
Why it beats ABCD2
Look at what the thirteen items include: atrial fibrillation on the ECG, known carotid stenosis, infarction already visible on CT, being on antiplatelet therapy despite which the event still happened. Those are mechanisms, not just demographics — and they are precisely what ABCD2 omits. In prospective multicentre validation, the Canadian TIA Score discriminated subsequent stroke risk better than ABCD2 and ABCD2i.1
One item runs the other way: a history of vertigo subtracts three points, because vertigo in this population more often reflects a peripheral vestibular cause than a cerebrovascular one. It is a useful reminder that the score is empirical — derived from what actually predicted stroke, not from what feels alarming.
Pitfall
The score was validated in patients who had already had an emergency-department evaluation including ECG, CT, and bloodwork. Applying it before that workup — over the phone, in a hallway, from a triage note — is using it outside the setting it was built for, and several of its highest-weighted items would simply be missing.
Reading the tiers
- Low (≤3): about 0.5% stroke within 7 days.
- Medium (4–8): about 2.3%.
- High (≥9): about 5.9%.
The tiers are about tempo. They tell you whether this patient needs a clinic appointment arranged, a specialist within two days, or a consultation before they leave the building. Longer discussion of the score's derivation, its comparison with ABCD2, and what it does not settle is in the full Canadian TIA Score review.
Frequently asked questions.
What is the Canadian TIA Score?
A 13-variable score, derived and prospectively validated in Canadian emergency departments, that estimates the risk of stroke within 7 days of a transient ischemic attack and sorts patients into low, medium, and high risk tiers.
How is it better than ABCD2?
It includes the mechanisms that drive early recurrence — atrial fibrillation, carotid stenosis, infarction on CT — which ABCD2 does not measure. In prospective head-to-head validation it discriminated subsequent stroke risk better than ABCD2 and ABCD2i.
Why does vertigo subtract points?
Because in the derivation data, vertigo was associated with lower subsequent stroke risk — it more often reflects a peripheral vestibular cause in this population. The score weights what predicted stroke empirically, not what sounds most alarming.
Can it be used to discharge a patient?
No. It grades how urgently follow-up and investigation should happen, not whether a patient can be sent home without them. It also assumes an emergency-department workup — ECG, CT, and bloodwork — has already been done.
What is the score range?
From −3 to 23. The vertigo item is the only one that subtracts, at −3 points.
References.
- Perry JJ, Sharma M, Sivilotti MLA, et al. Prospective validation of the Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study. BMJ. 2021;372:n49. PubMed
- Johnston SC, Rothwell PM, Nguyen-Huynh MN, et al. Validation and refinement of scores to predict very early stroke risk after transient ischaemic attack. Lancet. 2007;369(9558):283–292. PubMed
- Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2021;52(7):e364–e467. PubMed