OBJECTIVE: To compare the sensitivity and specificity of bedside diagnostic 
stroke scales in patients with suspected stroke.
DESIGN: A cross-sectional observational study of patients with suspected acute 
stroke in an emergency department in a UK hospital. DIAGNOSTIC SCALES: The 
results of an assessment with the Recognition of Stroke in the Emergency Room 
(ROSIER) scale, the Face Arm Speech Test (FAST) scale and the diagnosis of 
definite or probable stroke by an emergency department. Reference standard A 
consensus diagnosis of stroke or transient ischaemic attack (TIA) made after 
discussion by an expert panel (members included stroke physicians, neurologists 
and neuroradiologists), who had access to the clinical findings, imaging and 
subsequent clinical course, but were blinded to the results of the assessments 
by emergency-department staff.
RESULTS: In 356 patients with complete data, the expert panel assigned a 
diagnosis of acute stroke or TIA in 246 and a diagnosis of mimic in 110. The 
ROSIER had a sensitivity of 83% (95% CI 78 to 87) and specificity of 44% (95% CI 
34 to 53), and the FAST had a sensitivity of 81% (95% CI 76 to 86) and a 
specificity of 39% (95% CI 30 to 48). There was no detectable difference between 
the scales in sensitivity (p = 0.39) or specificity (p = 0.30).
CONCLUSIONS: The simpler FAST scale could replace the more complex ROSIER for 
the initial assessment of patients with suspected acute stroke in the emergency 
department.