Vol 6, No 3 (2021)
Research paper
Published online: 2021-07-12

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Validation of Recognition of Stroke in the Emergency Room scale in Turkish population and comparison of its efficiency with Face-Arm-Speech Test

Nurdan Yılmaz Şahin1, Mehmet Okumuş2, Isa Baspınar3, Burak Demirci3, Ahmet Çelik1
Disaster Emerg Med J 2021;6(3):112-118.


INTRODUCTION: Various risk scores were developed to recognize acute stroke easily and to start treatment right away in the emergency departments. Although the Recognition of Stroke in the Emergency Room (ROSIER) score used for this purpose is indicated better than the other scoring systems, it is expressed that it will be able to have social differentiations. In this study, we targeted to research validation of the ROSIER scale and to compare its efficiency with Face-Arm-Speech Test (FAST), another stroke diagnosis method, for the patients who applied to the emergency department with the stroke or transient ischemic attack symptoms.  

MATERIAL AND METHODS: The patients who reported to the emergency department with the suggestive symptoms or findings of stroke and were above 18 years of age were included in the study. The study forms were filled out by the emergency medicine specialist or the senior emergency medical assistant after the patients were evaluated, and then they were consulted by the neurology specialist. The final diagnosis, which was established after the clinical evaluation and necessary imaging done by the neurology specialists, was accepted as a standard reference.  

RESULTS: A total of 335 patients, including 168 (50.1%) females, were included in the study. The sensitivity was 68.5%, specificity was 79.0%, Positive Predictive Value (PPV) was 78.7%, NPV (Negative Predictive Value) was 68.9%, and test validity was 73.4% for the ROSIER scale. For the FAST scale the sensitivity was 63.5%, specificity was 88.5%, PPV was 86.3%, NPV was 68.1%, and test validity was 75.2%.  

CONCLUSION: In the present study, it was seen that the ROSIER scale could be used in separating the patients with CVO (cerebrovascular accident) from the patients who applied with the similar clinical findings. However, FAST was superior because its specificity and PPV were higher and its practicability was easier than the ROSIER.

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  1. Jiang Hl, Chan CPy, Leung Yk, et al. Evaluation of the Recognition of Stroke in the Emergency Room (ROSIER) scale in Chinese patients in Hong Kong. PLoS One. 2014; 9(10): e109762.
  2. Fothergill RT, Williams J, Edwards MJ, et al. Does use of the recognition of stroke in the emergency room stroke assessment tool enhance stroke recognition by ambulance clinicians? Stroke. 2013; 44(11): 3007–3012.
  3. Nor AM, Davis J, Sen B, et al. The Recognition of Stroke in the Emergency Room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005; 4(11): 727–734.
  4. Mingfeng He, Zhixin Wu, Qihong G, et al. Validation of the use of the ROSIER scale in prehospital assessment of stroke. Ann Indian Acad Neurol. 2012; 15(3): 191–195.
  5. Goldstein LB, Bushnell CD, Adams RJ, et al. American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council for High Blood Pressure Research,, Council on Peripheral Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42(2): 517–584.
  6. Mao H, Lin P, Mo J, et al. Development of a new stroke scale in an emergency setting. BMC Neurol. 2016; 16: 168.
  7. Byrne B, O'Halloran P, Cardwell C. Accuracy of stroke diagnosis by registered nurses using the ROSIER tool compared to doctors using neurological assessment on a stroke unit: a prospective audit. Int J Nurs Stud. 2011; 48(8): 979–985.
  8. O'Donnell MJ, Xavier D, Liu L, et al. INTERSTROKE investigators. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010; 376(9735): 112–123.
  9. Mackay MT, Churilov L, Donnan GA, et al. Performance of bedside stroke recognition tools in discriminating childhood stroke from mimics. Neurology. 2016; 86(23): 2154–2161.
  10. Brandler ES, Sharma M, Sinert RH, et al. Prehospital stroke scales in urban environments: a systematic review. Neurology. 2014; 82(24): 2241–2249.
  11. Brandler ES, Sharma M, Khandelwal P, et al. Abstract WP243: Identification of Common Confounders in the Prehospital Identification of Stroke in Urban, Underserved Minorities. Stroke; a journal of cerebral circulation. 2013; 44(Suppl 1): AWP243–AWP243.

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