Recognition of Stroke in the Emergency Room (ROSIER) Scale

ROSIER Scale

Loss of Consciousness or Syncope

Seizure Activity

Asymmetric Facial Weakness

Asymmetric Arm Weakness

Asymmetric Leg Weakness

Speech Disturbance

Visual Field Defect

ROSIER Score: 0

Stroke Unlikely

ROSIER score ≤0. Stroke is unlikely but cannot be completely excluded. Consider alternative diagnoses (syncope, seizure, etc.).

Distinguishes between acute stroke and stroke mimics.

Why Use

Compared to simpler stroke recognition scales, this tool includes additional items to help exclude stroke mimics and enhance specificity. Quickly differentiates stroke from non-stroke conditions in the emergency setting, helping prioritize patients for urgent neuroimaging.

When to Use

Use to assess patients presenting to the emergency room with acute neurological symptoms to screen for potential acute stroke.

Formula

Addition of the selected points: Finding Points Loss of consciousness or syncope Yes No -1 0 Seizure activity Yes No -1 0 New, acute onset (or upon awaking from sleep) finding of any of the following: Asymmetric facial weakness Yes No +1 0 Asymmetric arm weakness Yes No +1 0 Asymmetric leg weakness Yes No +1 0 Speech disturbance Yes No +1 0 Visual field defect Yes No +1 0

Pearls / Pitfalls

This tool does not replace imaging for definitive diagnosis. False negatives may occur, particularly in cases with seizure or syncope, which are scored with negative points.

Management

Score >0: Suggests the possibility of stroke, warranting immediate further evaluation. Coordinate with a stroke team or neurology consultant. Prioritize neuroimaging (e.g., CTA) and consider thrombolytic therapy if within the therapeutic window. Score ≤0: Stroke is unlikely but not completely excluded; if suspicion remains, consider consulting a neurology specialist. Consider alternative diagnoses and continue monitoring throughout the patient evaluation, as symptoms may evolve or warrant re-assessment.

Advice

This score should not be the sole determinant for a formal stroke evaluation; use this score in conjunction with a comprehensive evaluation and clinical judgment to assist in decision-making.

More Information

Likelihood of stroke: ROSIER Score Interpretation ≤0 Stroke unlikely >0 Stroke possible