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21-03-2011 | Stroke | Article

FAST could replace ROSIER in ED stroke diagnosis


Free abstract

MedWire News: Researchers report similar diagnostic accuracy for the ROSIER scale and the shorter, simpler FAST criteria.

The ROSIER (Recognition of Stroke in the Emergency Department [ED]) scale is the "most widely recommended" scale for ED diagnosis of stroke and transient ischemic attack (TIA), say William Whiteley (Western General Hospital, Edinburgh, UK) and colleagues.

It has eight variables, whereas FAST (Face Arm Speech Test) has just four.

Whiteley et al included 356 patients with completed ROSIER and FAST scales in their prospective study. In the original group of 405 patients, 376 had a completed FAST while 356 had a completed ROSIER test.

"The greater number of missing data for the ROSIER suggests that it is more difficult to complete than the FAST in the ED," comments the team in the Journal of Neurology, Neurosurgery, and Psychiatry.

ED staff used the ROSIER scale and FAST to assess the patients - before the treating neurologist provided an opinion.

An expert panel of stroke physicians, neurologists, and neuroradiologists subsequently determined that 246 of the patients had definite stroke or TIA, while 110 had a stroke mimic.

Based on the expert panel opinion, the ROSIER scale was 83% sensitive and 44% specific for stroke and TIA. FAST did not significantly differ from this, with a corresponding sensitivity and specificity of 81% and 39%.

"This study also provides support for a formalized scale for the identification of stroke in the emergency department," say the researchers.

The opinions of the ED staff - given before application of the diagnostic scales - were more specific than the results of the scales, at 59%, but less sensitive, at 76%.

However, Whiteley et al stress that sensitivity and specificity "do not have equal clinical value."

They say that failing to identify a stroke and not providing emergency treatment, such as thrombolysis, is potentially worse than mistaking a stroke mimic for a stroke.

"The use of one of these tools is likely to be of overall benefit," they conclude.

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid