The clinical relevance assessment of ROSIER scale in emergency care

Abstract

Stroke incidence and its consequences are nowadays a common cause of death, disability and financial burden for the health system. The scale of this phenomenon is estimated to increase in further years. To ensure the best patients care, therapy should be applied in a dedicated stroke unit as soon as possible. Nevertheless, even 2 out of 3 suspected patients visit the emergency department in the first place. The probable lack of knowledge and experience from the personnel indicates up to a 60% rate of misdiagnosis resulting in delays in treatment administration and consequently a reduction of chance for survival and full recovery. The Recognition of Stroke in the Emergency Room scale has been developed to improve the emergency physicians' assessment. It evaluates the initial event history and physical examination, which translates into a score from-2 to 5 with a > 0 cutoff point anticipating a high probability of stroke. Simple construction assures easy use and evaluation quality by all emergency staff members. The scale shows satisfactory accuracy, which establishes its superiority over the basic neurological examination, Face Arm Speech Time Test (FAST), and Cincinnati Prehospital Stroke Scale (CPSS) proven in several studies. On the contrary, the application is considerably reduced in cases of hemorrhage stroke, transient ischemic attack (TIA) and posterior circulation infarct in both adult and pediatric patients. Despite those limitations, the Recognition of Stroke in the Emergency Room Scale (ROSIER) scale constitutes a valuable instrument that can improve the insufficient stroke recognition rate and following patients' prognosis.