Recognition of Stroke in the Emergency Room (ROSIER) Scale

Introduction

ROSIER scale

ROSIER scale is used as a part of stroke early assessment (pre-hospital, emergency or acute stroke units) to help health care professionals diagnose stroke from its mimics in which presentation resembles or may even be indistinguishable from ischemic stroke. It consists of seven yes or no questions.

Pre - scale data items

• Assessment date and time.
• Symptoms onset (record date and time).
• Glasgow coma scale (record the 3 sub scores).
• Blood pressure.
• Blood Glucose level (if less than 3.5 mmol/l, treat urgently and reassess).

Scale categories

1. Loss of consciousness or syncope (score -1 for Yes, zero for No).
2. Seizure activity (score -1 for Yes, zero for No).
3. Facial weakness asymmetry (score +1 for Yes, zero for No).
4. Arm weakness asymmetry (score +1 for Yes, zero for No).
5. Leg weakness asymmetry (score +1 for Yes, zero for No).
6. Speech disturbance (score +1 for Yes, zero for No).
7. Visual field defects (score +1 for Yes, zero for No).

Results

Total score ranges from -2 to +5.

If > 0, stroke diagnosis is likely but keep nil orally until water swallow test is applied.

If < 0, stroke diagnosis is not excluded but further medical discussion is needed.

Validity

ROSIER is a sensitive tool for stroke provisional diagnosis. However, the ROSIER solely cannot be used to confidently rule out or identify stroke as a diagnosis. The comprehensive clinical assessment and further examination or imaging for potential stroke patients are still irreplaceable.