ROSIER Score

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(1)© State of Queensland (Queensland Health) 2012 Licensed under: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Contact: CIM@health.qld.gov.au. (Affix identification label here) URN:. Transient Ischaemic Attack (TIA) / Stroke Clinical Pathway Facility:. .......................................................................................................... ROSIER Score (Recognition Of. Family name: Given name(s): Address: Date of birth:. Sex: . M . F . I. 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. y l on se s u e s d o n p a rm r t u o n f p i l r r a p e n d ap o i oa p t a nl e r t s s w a u o h l l d c i r r u r o Fo t f e p o N eas l P (+1). Asymmetric leg weakness. (+1). Speech disturbance. (+1). Visual field 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. 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. Time of onset of acute neurological deficit :. Time unknown. Persistent neurology more 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. Mat. No.: 10248311. Admit / refer Stroke Unit. See local or national stroke management guidelines for further details. Persistent Neurology less than 4.5 hours since onset. Neurological deficit resolved. ?Thrombolysis Candidate. Non-contrast CT Brain. Contact Stroke, Medical or ED consultant urgently re: acute imaging See Statewide or local Thrombolysis protocol for further details. If CT: Ischaemia / NAD, Risk Stratify the TIA (see over). If CT: bleed, refer as appropriate. Signature log (every person documenting in this clinical pathway must supply a sample of Initials. Signature. Print name. SW245. ÌSW245|Î. v4.00 - 08/2012. am / pm. Page 1 of 2. their initials and signature below). Role. TRANSIENT ISCHAEMIC ATTACK (TIA) / STROKE CLINICAL PATHWAY. DO NOT WRITE IN THIS BINDING MARGIN. Primary and secondary survey.

(2) (Affix identification label here) URN:. Transient Ischaemic Attack (TIA) / Stroke Clinical Pathway. Family name: Given name(s): Address: Date of birth:. Sex: . M . F . I. Risk stratification of TIA ABCD² Score for Risk Stratification. Maximum score of 7.. (1). Admit to hospital See local or national stroke management guidelines If last symptoms were more than one week ago then treat as low risk. (1). 1 or more complicating factors. Age. High Risk TIA 4–7 points. y l on se s u e s d o n p a rm r t u o n f p i l r r a p e n d ap o i oa p t a nl e r t s s w a u o h l l d c i r r u r o Fo t f e p o N eas l P. 60 or more years Blood pressure. Systolic greater than or equal to 140 and / or Diastolic greater than or equal to 90 Clinical signs. (2). Speech disturbance without weakness. (1). Other. (0). Duration of symptoms. 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). No complicating factors. Less than 10 minutes. (0). 10 minutes – 1 hour. (1). More than 1 hour. (2). Diabetes. (1). Total:. 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 lipidlowering 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 Officer’s initials: ................................. Medication recommendations for patients discharged from ED (all to be given orally) Drug. Aspirin. Dose. 300 mg stat. Aspirin / Dipyridamole (Asasantin SR). 25/200 mg bd. Comments All patients in whom haemorrhage has been excluded with CT or MRI brain (unless contraindicated) To reduce the risk of side effects (e.g. headache): Week 1: Asasantin SR 25/200mg and Aspirin 75–150mg, 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 Page 2 of 2. DO NOT WRITE IN THIS BINDING MARGIN. Unilateral Weakness; OR. Low Risk TIA 0–3 points.

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