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ROSIER Score (Recognition Of Stroke In Emergency Room)
If the patient has had acute onset of symptoms, calculate the following score:
(+1) Asymmetric face weakness
(+1) Asymmetric arm weakness
(+1) Asymmetric leg weakness
(+1) Speech disturbance
(+1) Visual feld defect
(-1) Seizure activity
(-1) Loss of consciousness or syncope
Total (if the total score is +1 or more, or stroke is suspected on other clinical grounds then triage Category 2.
Possible score of -2 to +5.)
Assessment Completed Initial Time Date
Primary and secondary survey
Perform BGL on arrival (notify MO and treat if BGL < 3.5 mmol/L)
RMO to follow flowchart overleaf, and use as a guide to make clinical
decisions based upon the recommendations
Initial assessment
Signature log (every person documenting in this clinical pathway must supply a sample of their initials and signature below)
Initials Signature Print name Role
Time of onset of acute neurological deficit
:
am / pm
Time unknown
Persistent neurology more
than 4.5 hours since onset
Persistent Neurology less
than 4.5 hours since onset
Non-contrast CT Brain
(or MRI brain)
ECG (esp. re: ?AF)
Send FBC / ELFT / ESR and
request fasting lipids
Admit / refer Stroke Unit
See local or national stroke
management guidelines for
further details
Non-contrast CT Brain
If CT: bleed, refer as
appropriate
If CT: Ischaemia / NAD, Risk
Stratify the TIA (see over)
Neurological deficit resolved
?Thrombolysis Candidate
Contact Stroke, Medical or
ED consultant urgently re:
acute imaging
See Statewide or local
Thrombolysis protocol for
further details

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Page 1 of 2
(Affx identifcation label here)
URN:
Family name:
Given name(s):
Address:
Date of birth: Sex: M F I
Transient Ischaemic Attack (TIA)
/ Stroke Clinical Pathway
Facility: .........................................................................................................
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Risk stratifcation of TIA
ABCD Score for Risk Stratification.
Maximum score of 7.
Age
60 or more years (1)
Blood pressure
Systolic greater than or (1)
equal to 140 and / or
Diastolic greater than or
equal to 90
Clinical signs
Unilateral Weakness; OR (2)
Speech disturbance (1)
without weakness
Other (0)
Duration of symptoms
Less than 10 minutes (0)
10 minutes 1 hour (1)
More than 1 hour (2)
Diabetes (1)
Total:
Medication recommendations for patients discharged from ED (all to be given orally)
Drug Dose Comments
Aspirin 300 mg stat
All patients in whom haemorrhage has been excluded with CT or MRI brain (unless
contraindicated)
Aspirin / Dipyridamole
(Asasantin SR)
25/200 mg bd
To reduce the risk of side effects (e.g. headache):
Week 1: Asasantin SR 25/200mg and Aspirin 75150mg, each once daily
Week 2: Increase to Asasantin SR 25/200mg bd and CEASE Aspirin
For patients intolerant of Dipyridamole SR: Clopidogrel or Aspirin is recommended.
If currently taking Aspirin / Dipyridamole SR 25/200mg or Clopidogrel: recommend that this be continued.
If the patient is in Atrial Fibrillation: Admission for anticoagulation is recommended.
Clopidogrel 75 mg daily Only if aspirin contraindication or intolerance
Comments
This document serves as a guide and is not intended to replace clinical judgement.
Further information can be found in the National Stroke Foundation Clinical Guidelines for Stroke Management 2010
www.strokefoundation.com.au/news/welcome/clinical-guidelines-for-acute-stroke-management
Admit to hospital
See local or national stroke management guidelines
If last symptoms were more than one week ago then treat
as low risk
Complicating factors
New / untreated atrial fibrillation
Recurrent / crescendo TIAs
Carotid territory symptoms or known carotid artery disease
Other (if in doubt, discuss with stroke specialist or admit for
assessment)
Discharge from Emergency Department
Anti-platelet agent (unless contraindicated)
Arrange outpatient appointment within 1 week (include this
page with referral; tick when referral has been made)
Further imaging studies and consideration of antihypertensive and lipid-
lowering therapy will be addressed at the outpatients appointment
Advise not to drive or enter other risk situations until review
Advise smoking cessation if relevant
Notify LMO (include this page with letter)
Medical Offcers initials:
................................
1 or more complicating factors
No complicating factors
High Risk TIA
47 points
Low Risk TIA
03 points
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Page 2 of 2
(Affx identifcation label here)
URN:
Family name:
Given name(s):
Address:
Date of birth: Sex: M F I
Transient Ischaemic Attack (TIA)
/ Stroke Clinical Pathway
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