ROSIER Scale for Stroke Recognition
Recognition of Stroke in the Emergency Room (ROSIER) scale. Validated tool to distinguish stroke from stroke mimics in the emergency department.
Score interpretation
ROSIER ≤0 — stroke unlikely. Consider stroke mimic (seizure, syncope, metabolic).
→ Investigate for non-stroke cause; check blood glucose; toxicology screen; consider epilepsy, Todd's paresis, hypoglycaemia
ROSIER >0 — stroke likely (sensitivity 93%, specificity 83%)
→ Activate stroke pathway; urgent CT head; blood glucose; ECG; neurology team activation; thrombolysis eligibility assessment
Interpretation bands for the ROSIER Scale. Apply clinical judgement and local guidance.
References
- Nor AM 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.
Related
Curated clinical cross-links plus same-class fallbacks.
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Labetalol (IV — Hypertensive Emergency) · Combined alpha and beta blocker
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Alteplase (tPA) · Thrombolytic — Ischaemic Stroke / Massive PE
- Tenecteplase · Cardiovascular Emergency
- Tirofiban · Cardiovascular Emergency
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Featured in these MRCEM clinical pathways
The ROSIER Scale is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.