ED Procedures

In the ED, the initial priorities are a rapid structured assessment, and exclusion of hypoglycaemia.

The radiology department must be alerted so that there are no avoidable delays in obtaining rapid imaging of the brain.

One tool developed for use in the ED aimed at improving upon the sensitivity and specificity of the FACE assessment is ‘recognition of stroke in the emergency room’ (ROSIER) [7]. The scoring tool is outlined in the table below. This is also useful for an initial, structured assessment and triage of a patient self presenting to the ED.

Recognition of Stroke in the Emergency Room (ROSIER)

Score from -2 to +5

Clinical Hx: Score -1 for each

  • Loss of consciousness
  • Convulsive fit

Neuro signs: Score +1 for each

  • Face weakness
  • Arm weakness
  • Leg weakness
  • Speech disturbance
  • Visual field defect

A score of 1 or above makes stroke more likely (PPV 90% (CI 85-95%) NPV 88% (CI 83-93%).

If the score is negative, another diagnosis should be considered: a stroke mimic.