The validity of recognition of stroke in the emergency room (ROSIER) scale in the diagnosis of Iranian patients with acute ischemic stroke in the emergency department

Zangi, Mahdi; Karimi, Somayeh; Mirbaha, Sahar; Sotoodehnia, Mehran; Rasooli, Fatemeh; Baratloo, Alireza

doi:10.4103/2452-2473.301914

Cited by 4 publications

(11 citation statements)

References 17 publications

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“…11,15 ROSIER has assigned negative scores to seizure and syncope in order to better differentiate stroke and stroke mimics; also, by adding "new onset of symptoms", it has helped differentiate new stroke cases from old ones. 13,27 The key point that should be noted regarding the present study is that the instruments were only compared to a gold standard, namely MRI, and their effectiveness in dealing with patients on the scene may differ from the reported findings due to many reasons. For example, the level of knowledge and experience of the emergency medical technicians (EMTs) in this field is very important and a specific scale may not be useful due to difficulty on the scene.…”

Section: Discussionmentioning

confidence: 89%

“…In recent years, several clinical scales have been and PreHAST. [8][9][10][11][12][13][14][15] Choosing a scale depends on both its accuracy and ease of use. Confirming the accuracy of a scale by comparing it to other pre-hospital scales can play an important role in accurate diagnosis of acute stroke and thus, increases the chance of the patient benefiting from successful treatment.…”

Section: Introductionmentioning

confidence: 99%

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A Multicenter Diagnostic Accuracy Study on Prehospital Stroke Screening Scales

et al. 2021

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Background: Stroke is one of the most common debilitating diseases. Although effective treatment is available, a golden time has been defined in this regard. Therefore, prompt action is needed to identify patients with stroke as soon as possible, even in the pre-hospital stage. In recent years, several clinical scales have been introduced for this purpose. We performed the present study to examine the accuracy of eight clinical scales in terms of stroke diagnosis. Methods: This multicenter diagnostic accuracy study was conducted in 2019. All patients older than 18 years who were admitted to the emergency department (ED) and underwent brain magnetic resonance imaging (MRI) for a suspected stroke were eligible. All data were gathered through a pre-prepared checklist consisting of three sections, using the clinical records of the patients. The first section of the checklist included basic characteristics and demographic data. The second part included physical examination findings of 19 items related to the 8 scales. The third part was dedicated to the final diagnosis based on the interpretation of brain MRI, which was considered the gold standard for the diagnosis of acute ischemic stroke (AIS) in the current study. Results: The data from 805 patients suspected of stroke were analyzed. In all, 463 patients (57.5%) were male. The participants' age was 6-95 years with a mean age of 66.9 years (SD = 13.9). Of all the registered patients, 562 (69.8%) had an AIS. The accuracy of screening tests was 63.0% to 84.4%. The sensitivity and specificity were 71.9% to 95.7% and 46.5% to 82.8%, respectively. Among all the screening tests, Los Angeles Pre-Hospital Stroke Screening (LAPSS) had the lowest sensitivity, and Medic Prehospital Assessment for Code Stroke (Med PACS) had the highest sensitivity. In addition, PreHospital Ambulance Stroke Test (PreHAST) had the lowest specificity and LAPSS had the highest specificity. Conclusion:Based on the findings of the present study, highly sensitive tests that can be used in this regard are Cincinnati Prehospital Stroke Scale (CPSS), Face-Arm-Speech-Time (FAST), and Med PACS, all of which have about 95% sensitivity. On the other hand, none of the studied tools were desirable (specificity above 95%) in any of the examined cut-offs.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

A Multicenter Diagnostic Accuracy Study on Prehospital Stroke Screening Scales

et al. 2021

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“…Male dominance among TBI patients was also seen in other similar studies, and the young male group was victim of road traffic accidents. [8][9][10] Most of the studies did not report any patient comorbidities, as the maximum study participants were in the younger age group. 11 The median duration of mechanical ventilation, length of ICU stay, and length of hospital stay for the current study were 3 (0, 30), 5 (1,35), and 4 (0, 30) days, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Male dominance among TBI patients was also seen in other similar studies, and the young male group was victim of road traffic accidents. 8 9 10 Most of the studies did not report any patient comorbidities, as the maximum study participants were in the younger age group. 11 …”

Section: Discussionmentioning

confidence: 99%

Comparison of the Prognostic Accuracy of Full Outline of Unresponsiveness (FOUR) Score with Glasgow Coma Scale (GCS) Score among Patients with Traumatic Brain Injury in a Tertiary Care Center

Chattopadhyay,

Ramamoorthy,

Kumari

et al. 2024

Asian J Neurosurg

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Objectives The Glasgow Coma Scale (GCS) is widely used and considered the gold standard in assessing the consciousness of patients with traumatic brain injury. However, some significant limitations, like the considerable variations in interobserver reliability and predictive validity, were the reason for developing the Full Outline of Unresponsiveness (FOUR) score. The current study aims to compare the prognostic accuracy of the FOUR score with the GCS score for in-hospital mortality and morbidity among patients with traumatic brain injury. Materials and Methods A prospective cohort study was conducted, where 237 participants were selected by consecutive sampling from a tertiary care center. These patients were assessed with the help of GCS and FOUR scores within 6 hours of admission, and other clinical parameters were also noted. The level of consciousness was checked every day with the help of GCS and FOUR scores until their last hospitalization day. Glasgow Outcome Scale was used to assess their outcome on the last day of hospitalization. The GCS and FOUR scores were compared, and data were analyzed by descriptive and inferential statistics. The chi-square test, independent Student's t-test, and receiver operating characteristic analysis were used for inferential analysis. Results The area under the curve (AUC) for the GCS score at the 6th hour for predicting mortality was 0.865 with a cutoff value of 5.5, and it yields a sensitivity of 87% and a specificity of 64%. The AUC for FOUR scores at the 6th hour for predicting the mortality was 0.893, with a cutoff value of 5.5, and it yields a sensitivity of 87% and a specificity of 73%. Conclusion The current study shows that, as per the AUC of GCS and FOUR scores, their sensitivity was equal, but specificity was higher in the FOUR score. So, the FOUR score has higher accuracy than the GCS score in the prediction of mortality among traumatic brain injury patients.

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“…For several years, GCS has been the standard in assessing the level of consciousness. Although widely used, GCS has many limitations, including the inability to assess verbal scores in patients who have been intubated or have aphasia, as well as the inconsistent reliability between assessors in properly documenting medical records (Baratloo et al, 2017) The FOUR scale is a new comma scale that is widely developed and validated in adults as a proposed alternative to perfect GCS, and does not rely on verbal responses. Decreased GCS and FOUR scores are associated with a worsening level of consciousness (Nair et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Accuracy of the GCS and Four Scale Assessments to the Prognosis of Integrative Review Consciousness Disorder Patients

Arsyad,

Arafat,

LSjattar

2022

IJOMS

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The FOUR Scale is an awareness assessment score. Its theoretical benefit over pre-existing scores is the evaluation of brainstem reflexes and breathing patterns which allows a better assessment of patients with severe impairment of consciousness. The article search was carried out using the Four Data Bases. Inclusion criteria were: human, adult, prospective randomized controlled trial; prospective, cohort/control, case series, prospective, and retrospective studies. Inclusion and exclusion criteria were applied to each article to get the final article for review. Results in the adult population are presented here. Data were reported following the preferred reporting items for integrative review and meta-analysis guidelines. Initial search returned 103 citations. after screening the remaining 65 were for full-text review and 45 were excluded because they were based on review titles and abstracts and did not meet study design and population criteria. Patient categories included traumatic brain injury, intraventricular hemorrhage, intracerebral hemorrhage, subarachnoid hemorrhage, ischemic stroke, general neurology/ combined and neurosurgery, general critical illness/medicine, and patients in the emergency department. Until the remaining 20 studied. Twelve studies demonstrated good interobserver reliability of the FOUR Scale. Three studies demonstrated the prognostic value of the FOUR Scale in predicting mortality and functional outcomes. Five studies demonstrated equivalence between the FOUR Scales compared with the Glasgow Coma Score in predicting mortality and functional outcome. The FOUR Scale has been shown to be a good predictor of outcome in many patients with decreased level of consciousness. So this can provide an overview to nurses in assessing a good level of awareness and reliability.

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The validity of recognition of stroke in the emergency room (ROSIER) scale in the diagnosis of Iranian patients with acute ischemic stroke in the emergency department

Cited by 4 publications

References 17 publications

A Multicenter Diagnostic Accuracy Study on Prehospital Stroke Screening Scales

A Multicenter Diagnostic Accuracy Study on Prehospital Stroke Screening Scales

Comparison of the Prognostic Accuracy of Full Outline of Unresponsiveness (FOUR) Score with Glasgow Coma Scale (GCS) Score among Patients with Traumatic Brain Injury in a Tertiary Care Center

Comparison of the Accuracy of the GCS and Four Scale Assessments to the Prognosis of Integrative Review Consciousness Disorder Patients

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