Assessment of suspected stroke

Initial clinical assessment remains the cornerstone in the diagnosis of stroke and TIA. Further investigations and brain imaging are undertaken to confirm the diagnosis and are essential for a decision on intervention, but the initial assessment at a minimum determines whether the patient has acute, focal or neurological deficits.

There are a number of clinical assessment tools available for emergency department staff, such as FAST, Recognition of Stroke in the Emergency Room (ROSIER), and the National Institutes of Health Stroke Scale (NIHSS). The reliability of assessment tools improves with experience and confidence, suggesting the need for a close working relationship between emergency department staff and stroke specialists, and the development of rapid referral processes.

For current research and evidence-based recommendations see our Clinical Guidelines.