ROSIER Scale Calculator

ROSIER Scale Calculator for Neurology. Neither a positive score nor a nonpositive score settles the diagnosis. Suspected stroke remains urgent, including when the total is zero.

For shared guidance on choosing a tool and documenting results, read the clinical calculator workflow.

How this calculator works

Subtract one each for loss of consciousness/syncope and seizure; add one each for five new focal findings. Total -2 to 5; >0 is positive. Original report: https://pubmed.ncbi.nlm.nih.gov/16239179/

When to use this calculator

Support emergency-department stroke recognition, with glucose and mimics assessed. NICE guidance supports ROSIER in the ED: https://www.nice.org.uk/guidance/NG128/chapter/recommendations

Inputs used

  • Acute symptomatic stroke assessment with glucose assessed
  • Loss of consciousness or syncope
  • Seizure activity
  • New asymmetric facial weakness
  • New asymmetric arm weakness
  • New asymmetric leg weakness
  • New speech disturbance
  • New visual-field defect

Clinical interpretation

Neither a positive score nor a nonpositive score settles the diagnosis. Suspected stroke remains urgent, including when the total is zero.

Worked example

Seizure (-1), new arm weakness (+1) and new speech disturbance (+1), with the other findings absent, gives +1: a positive screen despite seizure.

Limitations and safety notes

The original study excluded asymptomatic TIA. Prehospital performance should not be assumed identical to ED performance; a prospective ambulance study did not find ROSIER superior to FAST: https://pubmed.ncbi.nlm.nih.gov/24072006/

Frequently asked questions

Does seizure rule out stroke?

No. It subtracts one point in ROSIER, but stroke can still be present. The total and the clinical evaluation are separate.

References

  • Nor et al. ROSIER derivation and validation, 2005: https://pubmed.ncbi.nlm.nih.gov/16239179/
  • NICE NG128; glucose assessment and ED stroke recognition: https://www.nice.org.uk/guidance/NG128/chapter/recommendations
  • Fothergill et al. Prehospital ROSIER validation, 2013: https://pubmed.ncbi.nlm.nih.gov/24072006/

Editorial review and citation methodology

Maintained by the Quick Medical Calculator Editorial Team. Content record date: September 9, 2026. A content date is not evidence of independent clinical review. Individual clinical sign-off is not recorded on this page.

  • Prefer original validation studies for scoring systems and prediction tools.
  • Use current specialty society guidance, transplant allocation policy, public health guidance, or regulator resources when they govern clinical use.
  • Include limitations and safety notes when a calculator is population-specific, context-dependent, or unsuitable as a standalone decision tool.

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