Statistical & Clinical Analysis
ROSIER Scale Formula: Recognition of Stroke in the Emergency Room (-2 to +5)
Distinguish acute stroke/TIA (ROSIER > 0) from seizure or syncope mimics using Azlisham Mohd Nor’s 7-item emergency triage score (-2 to +5 points) after excluding hypoglycemia.
Why ROSIER subtracts -1 point each for loss of consciousness/syncope and seizure activity—after checking blood glucose >= 3.5 mmol/L first!
Prehospital FAST screens miss visual-field strokes and frequently false-trigger on post-ictal Todd’s paresis or vasovagal syncope! Azlisham Mohd Nor et al. (2005, The Lancet Neurology — Newcastle Acute Stroke Service, 93% sensitivity and 83% specificity at cutoff > 0) created the ROSIER emergency department scale: FIRST confirm capillary blood glucose >= 3.5 mmol/L (63 mg/dL) to rule out hypoglycemic hemiparesis;
then subtract -1 point for Loss of Consciousness/Syncope and -1 point for Seizure activity, while adding +1 point each for new acute Asymmetric Facial Weakness, Asymmetric Arm Weakness, Asymmetric Leg Weakness, Speech Disturbance, and Visual Field Defect (range -2 to +5)! Any ROSIER score > 0 (+1 to +5) mandates immediate Code Stroke CT and thrombolysis/thrombectomy evaluation!
| Clinical Presentation (Glucose >= 3.5 mmol/L) | Mimic Deductions vs Focal Signs | ROSIER Score (-2 to +5) | ED Code Stroke Triage |
|---|---|---|---|
| Face + Arm + Speech Deficit, No Syncope/Seizure | 0 Deductions + 3 Focal | +3 | "Stroke Likely (ROSIER > 0 — Urgent Brain CT)" |
| Witnessed Seizure + Transient Arm Weakness | -1 Seizure + 1 Arm | 0 | "Stroke Unlikely (ROSIER <= 0 — Evaluate Mimics)" |
| Capillary Glucose 2.4 mmol/L (< 3.5 mmol/L) | Mandatory Pre-Check | "Correct Hypoglycemia (< 3.5 mmol/L) First" | Hypoglycemia Mimic Guard |
ROSIER Emergency Room Stroke Score (-2 to +5 Points, Glucose Guarded)
Checks capillary blood glucose B2 >= 3.5 mmol/L first, then evaluates SUM(B5:B9) - B3 - B4 across the 2 mimic items and 5 focal neurological deficits.
=IF(B2 <= 0, "Invalid Glucose Input", IF(B2 < 3.5, "Correct Hypoglycemia (< 3.5 mmol/L) First", IF(OR(MIN(B3:B9) < 0, MAX(B3:B9) > 1), "Flags Must Be 0 or 1", SUM(B5:B9) - B3 - B4)))NICE CG68 / Newcastle ROSIER > 0 Code Stroke Decision Rule
Triggers urgent stroke imaging whenever ROSIER > 0 after normoglycemia verification.
=IF(B2 <= 0, "Invalid Glucose Input", IF(B2 < 3.5, "Correct Hypoglycemia (< 3.5 mmol/L) First", IF(OR(MIN(B3:B9) < 0, MAX(B3:B9) > 1), "Flags Must Be 0 or 1", IF(SUM(B5:B9) - B3 - B4 > 0, "Stroke Likely (ROSIER > 0 — Urgent Brain CT)", "Stroke Unlikely (ROSIER <= 0 — Evaluate Mimics)"))))Try the example
Use the original values or change them to test your understanding.