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Vol 7, No 3 (2022)
Review article
Published online: 2022-08-18
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The clinical relevance assessment of ROSIER scale in emergency care

Dawid Woszczyk1, Tomasz Kłosiewicz2
·
Medical Research Journal 2022;7(3):249-255.
Affiliations
  1. Students’ Scientific Circle of Emergency Medicine, Poznan University of Medical Sciences, Poznan, Poland
  2. Department of Medical Rescue, Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland

open access

Vol 7, No 3 (2022)
REVIEW ARTICLES
Published online: 2022-08-18

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 cut-off 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.

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 cut-off 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.

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Keywords

ROSIER scale, stroke, instrument characteristics, validation studies, emergency medicine

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About this article
Title

The clinical relevance assessment of ROSIER scale in emergency care

Journal

Medical Research Journal

Issue

Vol 7, No 3 (2022)

Article type

Review article

Pages

249-255

Published online

2022-08-18

Page views

4271

Article views/downloads

893

DOI

10.5603/MRJ.a2022.0040

Bibliographic record

Medical Research Journal 2022;7(3):249-255.

Keywords

ROSIER scale
stroke
instrument characteristics
validation studies
emergency medicine

Authors

Dawid Woszczyk
Tomasz Kłosiewicz

References (50)
  1. Feigin VL, Krishnamurthi RV, Parmar P, et al. GBD 2013 Writing Group, GBD 2013 Stroke Panel Experts Group. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015; 45(3): 161–176.
  2. Ramos-Lima MJ, Brasileiro de Carvalho I, Lima TL, et al. Quality of life after stroke: impact of clinical and sociodemographic factors. Clinics (Sao Paulo). 2018; 73: e418.
  3. GBD 2016 Neurology Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18(5): 439–458.
  4. Wafa HA, Wolfe CDA, Emmett E, et al. Burden of stroke in europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years. Stroke. 2020; 51(8): 2418–2427.
  5. Langhorne P, Ramachandra S. Stroke Unit Trialists' Collaboration. Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database Syst Rev. 2020; 4: CD000197.
  6. Adeoye O, Nyström KV, Yavagal DR, et al. Recommendations for the establishment of stroke systems of care: a 2019 update. Stroke. 2019; 50(7): e187–e210.
  7. Emberson J, Lees KR, Lyden P, et al. Stroke Thrombolysis Trialists' Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014; 384(9958): 1929–1935.
  8. Adams H, Zoppo Gd, Alberts M, et al. Guidelines for the early management of adults with ischemic stroke. Circulation. 2007; 115(20).
  9. Kothari R, Hall K, Brott T, et al. Early stroke recognition: developing an out-of-hospital NIH Stroke Scale. Acad Emerg Med. 1997; 4(10): 986–990.
  10. Harbison J, Hossain O, Jenkinson D, et al. Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke. 2003; 34(1): 71–76.
  11. Kidwell CS, Saver JL, Schubert GB, et al. Design and retrospective analysis of the Los Angeles Prehospital Stroke Screen (LAPSS). Prehosp Emerg Care. 1998; 2(4): 267–273.
  12. Bray JE, Martin J, Cooper G, et al. Paramedic identification of stroke: community validation of the melbourne ambulance stroke screen. Cerebrovasc Dis. 2005; 20(1): 28–33.
  13. Studnek JR, Asimos A, Dodds J, et al. Assessing the validity of the Cincinnati prehospital stroke scale and the medic prehospital assessment for code stroke in an urban emergency medical services agency. Prehosp Emerg Care. 2013; 17(3): 348–353.
  14. Chenkin J, Gladstone DJ, Verbeek PR, et al. Predictive value of the Ontario prehospital stroke screening tool for the identification of patients with acute stroke. Prehosp Emerg Care. 2009; 13(2): 153–159.
  15. 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.
  16. Aroor S, Singh R, Goldstein LB. BE-FAST (Balance, Eyes, Face, Arm, Speech, time): reducing the proportion of strokes missed using the FAST mnemonic. Stroke. 2017; 48(2): 479–481.
  17. Andsberg G, Esbjörnsson M, Olofsson A, et al. PreHospital Ambulance Stroke Test - pilot study of a novel stroke test. Scand J Trauma Resusc Emerg Med. 2017; 25(1): 37.
  18. Béjot Y, Daubail B, Giroud M. Epidemiology of stroke and transient ischemic attacks: Current knowledge and perspectives. Rev Neurol (Paris). 2016; 172(1): 59–68.
  19. Feigin V, Lawes C, Bennett D, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. The Lancet Neurology. 2009; 8(4): 355–369.
  20. Kelly-Hayes M, Beiser A, Kase CS, et al. The influence of gender and age on disability following ischemic stroke: the Framingham study. J Stroke Cerebrovasc Dis. 2003; 12(3): 119–126.
  21. Centers for Disease Control and Prevention (CDC). Prevalence and most common causes of disability among adults--United States, 2005. MMWR Morb Mortal Wkly Rep. 2009; 58(16): 421–426.
  22. Rajsic S, Gothe H, Borba HH, et al. Economic burden of stroke: a systematic review on post-stroke care. Eur J Health Econ. 2019; 20(1): 107–134.
  23. Strilciuc S, Grad DA, Radu C, et al. The economic burden of stroke: a systematic review of cost of illness studies. J Med Life. 2021; 14(5): 606–619.
  24. GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2021; 20(10): 795–820.
  25. Shah R, Wilkins E, Nichols M, et al. Epidemiology report: trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data. Eur Heart J. 2019; 40(9): 755–764.
  26. Rudd AG, Bladin C, Carli P, et al. Utstein recommendation for emergency stroke care. Int J Stroke. 2020; 15(5): 555–564.
  27. Liberman AL, Prabhakaran S. Stroke chameleons and stroke mimics in the emergency department. Curr Neurol Neurosci Rep. 2017; 17(2): 15.
  28. Tarnutzer AA, Lee SH, Robinson KA, et al. ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging: A meta-analysis. Neurology. 2017; 88(15): 1468–1477.
  29. 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.
  30. 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.
  31. DeVon HA, Zrelak P. Nurses trained in the use of the ROSIER tool can assess signs and symptoms of stroke with comparable accuracy to doctors performing standard neurological assessment. Evid Based Nurs. 2012; 15(2): 64.
  32. 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.
  33. Terzoni S, Destrebecq A, Modaffari F, et al. Validation of the Italian version of the ROSIER scale for stroke patients at triage. Australas Emerg Care. 2022; 25(2): 167–171.
  34. Mao H, Lin P, Mo J, et al. Development of a new stroke scale in an emergency setting. BMC Neurol. 2016; 16: 168.
  35. Purrucker JC, Hametner C, Engelbrecht A, et al. Comparison of stroke recognition and stroke severity scores for stroke detection in a single cohort. J Neurol Neurosurg Psychiatry. 2015; 86(9): 1021–1028.
  36. He M, Wu Z, Zhou J, et al. ROSIER scale is useful in an emergency medical service transfer protocol for acute stroke patients in primary care center: A southern China study. Neurol Asia. 2017; 22(2).
  37. Şahin NY, Okumuş M, Baspınar I, et al. Validation of Recognition of Stroke in the Emergency Room scale in Turkish population and comparison of its efficiency with Face-Arm-Speech Test. Disaster Emerg Med. 2021; 6(3): 112–118.
  38. 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.
  39. Whiteley WN, Wardlaw JM, Dennis MS, et al. Clinical scores for the identification of stroke and transient ischaemic attack in the emergency department: a cross-sectional study. J Neurol Neurosurg Psychiatry. 2011; 82(9): 1006–1010.
  40. National Center for Injury Prevention and Control. CDC. 10 Leading Causes of Death by Age Group, United States – 2018. https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2018-508.pdf (22.06.2022).
  41. Yock-Corrales A, Babl FE, Mosley IT, et al. Can the FAST and ROSIER adult stroke recognition tools be applied to confirmed childhood arterial ischemic stroke? BMC Pediatr. 2011; 11: 93.
  42. Barra M, Faiz KW, Dahl FA, et al. Stroke Mimics on the Stroke Unit - Temporal trends 2008-2017 at a large Norwegian university hospital. Acta Neurol Scand. 2021; 144(6): 695–705.
  43. McClelland G, Rodgers H, Flynn D, et al. The frequency, characteristics and aetiology of stroke mimic presentations: a narrative review. Eur J Emerg Med. 2019; 26(1): 2–8.
  44. Zangi M, Karimi S, Mirbaha S, et al. The validity of recognition of stroke in the emergency room (ROSIER) scale in the diagnosis of Iranian patients with acute ischemic stroke in the emergency department. Turk J Emerg Med. 2021; 21(1): 1–5.
  45. Mallick AA, Ganesan V, Kirkham FJ, et al. Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study. Lancet Neurol. 2014; 13(1): 35–43.
  46. Rudd M, Buck D, Ford GA, et al. A systematic review of stroke recognition instruments in hospital and prehospital settings. Emerg Med J. 2016; 33(11): 818–822.
  47. Brunton L, Boaden R, Knowles S, et al. Pre-hospital stroke recognition in a UK centralised stroke system: a qualitative evaluation of current practice. Br Paramed J. 2019; 4(1): 31–39.
  48. Oostema JA, Konen J, Chassee T, et al. Clinical predictors of accurate prehospital stroke recognition. Stroke. 2015; 46(6): 1513–1517.
  49. Jackson A, Deasy C, Geary UM, et al. Validation of the use of the ROSIER stroke recognition instrument in an Irish emergency department. Ir J Med Sci. 2008; 177(3): 189–192.
  50. 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.

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