Stroke Unit, Level 6, Daisy Hill Hospital, 5 Hospital Road, Newry, Co.Down BT35 8DR, UK.
Int J Nurs Stud. 2011 Aug;48(8):979-85. doi: 10.1016/j.ijnurstu.2011.01.015. Epub 2011 Feb 26.
Recombinant tissue plasminogen activator (rT-PA) is an effective treatment for acute ischaemic stroke when given within 3h of symptom onset but can be delayed as patients wait for a diagnosis. The ROSIER assessment tool (Fig. 1) has been found to be effective in diagnosing stroke but to date has only been tested when used by doctors.
To compare registered nurses' ability to diagnose stroke using the ROSIER assessment tool with doctors' ability to diagnose stroke using traditional neurological assessment.
DESIGN, SETTING, AND PARTICIPANTS: A prospective audit of all suspected stroke patients (n=106) admitted to the stroke unit of a district general hospital over an eight month period, assessed by registered nurses trained to use the ROSIER assessment tool to identify stroke.
Time from admission to the stroke unit until initial assessment by doctors and registered nurses. Comparison of initial diagnosis by doctors and registered nurses with final diagnosis by a consultant for stroke.
Of 106 suspected stroke patients, 78 (73.5%) had a final diagnosis of stroke or transient ischaemic attack (TIA) and 28 (26.4%) had an alternative diagnosis. Six patients with TIA were subsequently excluded as they were asymptomatic at the time of assessment, leaving 100 participants in the validation phase of the study. Using the ROSIER tool registered nurses achieved a diagnostic sensitivity for stroke of 98% (95% confidence interval 88-99), positive predictive value (PPV) 83% (95% confidence interval 73-90). Doctors using standard neurological assessment had a similar diagnostic sensitivity of 94% (95% confidence interval 86-98), PPV 80% (95% confidence interval 70-88). The mean time from initial assessment by registered nurses using the ROSIER tool, until assessment by doctor on the stroke unit was 75 min (SD=65.8 min).
Registered nurses working on a stroke unit using the ROSIER assessment tool are able to diagnose stroke with a degree of accuracy comparable to doctors using clinical neurological assessment. Prompt assessment of suspected stroke patients by registered nurses using the ROSIER tool could reduce delays in eligible stroke patients being assessed for rT-PA treatment.
重组组织型纤溶酶原激活剂（rT-PA）在症状发作后 3 小时内用于急性缺血性中风是有效的治疗方法，但由于患者需要等待诊断，因此可能会延迟。ROSIER 评估工具（图 1）已被证明在诊断中风方面是有效的，但迄今为止，它仅在医生使用时进行了测试。
比较注册护士使用 ROSIER 评估工具诊断中风的能力与医生使用传统神经学评估诊断中风的能力。
设计、地点和参与者：对在一家地区综合医院中风病房住院的所有疑似中风患者（n=106）进行前瞻性审核，这些患者由接受过使用 ROSIER 评估工具识别中风培训的注册护士进行评估。
从入院到中风病房到医生和注册护士首次评估的时间。医生和注册护士的初步诊断与中风顾问的最终诊断进行比较。
在 106 名疑似中风患者中，78 名（73.5%）最终诊断为中风或短暂性脑缺血发作（TIA），28 名（26.4%）有其他诊断。6 名 TIA 患者随后被排除在外，因为他们在评估时无症状，因此研究的验证阶段共有 100 名参与者。使用 ROSIER 工具，注册护士诊断中风的敏感性为 98%（95%置信区间 88-99），阳性预测值（PPV）为 83%（95%置信区间 73-90）。使用标准神经学评估的医生具有相似的诊断敏感性，为 94%（95%置信区间 86-98），PPV 为 80%（95%置信区间 70-88）。注册护士使用 ROSIER 工具进行初始评估后，到中风病房医生进行评估的平均时间为 75 分钟（SD=65.8 分钟）。
在中风病房工作的注册护士使用 ROSIER 评估工具诊断中风的准确性可与使用临床神经学评估的医生相媲美。注册护士使用 ROSIER 工具快速评估疑似中风患者可减少符合 rT-PA 治疗条件的中风患者评估的延迟。
