Clinical scores for the identification of stroke and transient ischaemic attack in the emergency department: a cross-sectional study

Objective To compare the sensitivity and specificity of bedside diagnostic stroke scales in patients with suspected stroke. Design A cross-sectional observational study of patients with suspected acute stroke in an emergency department in a UK hospital. Diagnostic scales The results of an assessment with the Recognition of Stroke in the Emergency Room (ROSIER) scale, the Face Arm Speech Test (FAST) scale and the diagnosis of definite or probable stroke by an emergency department. Reference standard A consensus diagnosis of stroke or transient ischaemic attack (TIA) made after discussion by an expert panel (members included stroke physicians, neurologists and neuroradiologists), who had access to the clinical findings, imaging and subsequent clinical course, but were blinded to the results of the assessments by emergency-department staff. Results In 356 patients with complete data, the expert panel assigned a diagnosis of acute stroke or TIA in 246 and a diagnosis of mimic in 110. The ROSIER had a sensitivity of 83% (95% CI 78 to 87) and specificity of 44% (95% CI 34 to 53), and the FAST had a sensitivity of 81% (95% CI 76 to 86) and a specificity of 39% (95% CI 30 to 48). There was no detectable difference between the scales in sensitivity (p=0.39) or specificity (p=0.30). Conclusions The simpler FAST scale could replace the more complex ROSIER for the initial assessment of patients with suspected acute stroke in the emergency department.