MDCalc

Recognition of Stroke in the Emergency Room (ROSIER) Scale

Distinguishes between acute stroke and stroke mimics.

Loss of consciousness or syncope
Seizure activity

New, acute onset (or on awakening from sleep) finding of any of the following:

Asymmetric facial weakness
Asymmetric arm weakness
Asymmetric leg weakness
Speech disturbance
Visual field defect

Result:

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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.

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.