J Neurol Neurosurg Psychiatry 82:1006-1010 doi:10.1136/jnnp.2010.235010
  • Research paper

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

  1. Peter A G Sandercock1
  1. 1Bramwell Dott Building, Division of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK
  2. 2SFC Brain Imaging Research Centre, Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, University of Edinburgh, Western General Hospital, Edinburgh, UK
  1. Correspondence to Dr William N Whiteley, Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK; william.whiteley{at}
  1. Contributors WNW wrote the first draft, and collected and analysed the data. WNW, JMW, MSD and PAGS conceived and designed the study. JMW, MSD and PAGS revised the manuscript critically for important intellectual content. WNW is the guarantor.

  • Received 15 November 2010
  • Revised 24 January 2011
  • Accepted 1 February 2011
  • Published Online First 14 March 2011


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.


  • Funding WNW was supported the Chief Scientist's Office (CAF/06/30) and is now funded by a Clinician Scientist Fellowship from the UK Medical Research Council (G0902303). JMW was supported by the SFC through the Scottish Imaging Network, a Platform for Scientific Excellence Collaboration. MSD and PAGS were employed by the University of Edinburgh.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Scotland A Research Ethics Committee (REC Reference No: 06/MRE00/119).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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