Background: The Recognition of Stroke in The Emergency Room (ROSIER( scale has been designed to provide physicians in the emergency department with a framework which can be used to assess patients with suspected stroke and to facilitate early identification of acute stroke & appropriate referral. Aims: To assess the sensitivity and specificity of the ROSIER score in order to improve outcome of stoke patients. Methodology: The current study was designed as a prospective cross sectional study that included Patients over 18 years of age with suspected stroke presenting at emergency department in Suez Canal university hospital. Results: Patients with stroke formed about 65.2% of the patients with suspected stroke in the ER. Patients with stroke/ TIA were found to have significantly higher age compared to other patients (63.58 ±12.55 vs 39.18±11.12) (p<0.001). The most frequent comorbid diseases among patients were hypertension and diabetes mellitus. For ROSIER accuracy, a value of 1.00 or more was found to be the best cut-off point for prediction of stoke among patients attending with suspected stroke, with sensitivity = 98.3% and specificity = 87.5 % and accuracy= 94.5%. Conclusion: The ROSIER scale is simple, rapid, effective and sensitive screening tool in early detection of patients presenting with stroke and differentiating stroke from stroke mimics in the emergency room.