Why is this research needed?
Imagine you're a paramedic in a rural area of the UK, arriving at someone's home in response to a 999 call. Your patient has lost strength in their left arm and is having trouble speaking. They might be having a stroke, or they might be having a seizure.
The nearest hospital has seizure medications, but no brain scanner and no stroke treatments. For those, you'd have to go to a bigger hospital, which is much further away.
Both strokes and seizures are medical emergencies and need treating as quickly as possible. If you're wrong about what your patient has, that could mean a potentially fatal delay to treatment. What do you do?
This kind of dilemma is fairly common for ambulance personnel. The signs that someone is having a stroke could also be signs of many other conditions like seizures, migraines and blood poisoning. It's not surprising, then, that at least a third of emergency ambulance admissions for stroke turn out not to be strokes at all.
Now, imagine again that you're that paramedic, only this time you're carrying a test. The test can tell you within ten minutes whether your patient is having a stroke. Imagine how much easier your decision would be.
That test is what the GHoSt team want to create.
What are the aims of this research?
When the brain is injured, it releases small fragments of genetic material called sncRNAs, and these quickly make their way into our saliva. Different sncRNAs are released in response to different types of injury, and the GHoSt team have already created a test which can detect sncRNAs that are released when someone is concussed.
They now want to apply this same method for strokes.
First, the paramedics working on the project will ask people having a suspected stroke if they are willing to give saliva and blood samples, immediately and over the next few weeks. These samples can be taken without disrupting standard care - for example, in the ambulance on the way to the hospital. Participants will also be asked to give urine samples once they're in hospital.
The GHoSt team will then do a genetic analysis on the saliva samples to compare the sncRNAs. They will look for differences between people who had a stroke and people who turned out to have a different condition, like a seizure. They will also look for differences between people who had clotting strokes and people who had bleeding strokes.
Saliva samples are much easier to take than blood and urine samples, but it is possible that there won't be any differences in the saliva. The blood and urine samples will be stored as a back-up for future analysis if they're needed.
From their analysis, they hope to develop a rapid test that can quickly tell a paramedic whether someone is having a stroke and, ideally, whether it is a clotting stroke or bleeding stroke.
The GHoSt team think it might also be possible to predict what kind of recovery someone will have after a stroke from their sncRNAs. They will therefore ask some of their participants later on about life after stroke. This will include questionnaires on quality of life, mental health, sleep, thinking and memory. The team will look for links between the sncRNAs and how people respond on the questionnaires. This information will help them with planning a future study on the same topic with a much larger group of participants.
What is the benefit of this research?
Ultimately, if the team are successful in developing a rapid point-of-care test for stroke, it will save lives and improve outcomes for stroke survivors by allowing people to access treatment within the critical few hours after a stroke starts. This will be for a variety of reasons:
- Generalist healthcare professionals like paramedics and GPs will be able to tell quickly tell if someone is having a stroke and if so, what kind.
- Stroke units could be notified ahead of time that a patient is on the way, giving them time to prepare for thrombectomy, thrombolysis or other treatments.
- In places where brain scans are not routinely available due to cost or infrastructure, stroke professionals will have a way to tell whether someone is having a clotting or bleeding stroke and to treat with the right kind of drugs.
What PSP priorities does this research link to?
From 2019 to 2021, we worked with the James Lind Alliance on the Stroke Priority Setting Partnership (PSP). During the PSP process, we collaborated with people with lived experience of stroke and stroke professionals to find out what they thought were the top priorities in stroke research. From this, we identified the top ten priorities in two areas: prevention, diagnosis and short-term care, and rehabilitation and long-term care.
Now, when researchers apply to us for funding, we require that their work addresses at least one of these priorities, or a priority from the Childhood Neurological Disabilities PSP Top 10 as it relates to childhood stroke.
GHoSt addresses the following priorities from the Stroke PSP:
- Prevention 2: Recognising and responding to stroke and TIA
- Prevention 6: Increasing the number of people accessing thrombectomy
Meet the team
GHoSt is led by Professor Tony Belli, Professor of Trauma Neurosurgery at the University of Birmingham and an Honorary Consultant Neurosurgeon at Queen Elizabeth Hospital in Birmingham. He is also Director of the NIHR's Surgical Reconstruction and Microbiology Research Centre, a national hub for trauma research.
Tony says, "Timely stroke diagnosis is key to successful treatment and better outcomes for patients. This research can significantly accelerate the diagnosis of stroke in the community, thereby reducing death and disability. It could be particularly helpful in less economically developed countries, where the cost of brain scanning is prohibitive for many families and where a stroke in a loved one could mean the entire family thrown into poverty and destitution."
The other members of the team are:
- Andy Rosser, Head of Research at West Midlands Ambulance Service NHS Foundation Trust. Andy oversees participant recruitment by paramedics attending suspected stroke.
- Hazel Smith, Portfolio Manager at University Hospitals Birmingham NHS Foundation Trust. Hazel oversees the process of following up with participants once they arrive in hospital. She's also the person who came up with the idea for GHoSt, based on her own experiences of the difficulty of deciding what to do in cases of suspected stroke.
- Dr Mark Willmot, Consultant Neurologist and lead of the Hyperacute Stroke Unit at University Hospitals Birmingham NHS Foundation Trust. He oversees the clinical procedures of the study, like taking saliva samples.
- Zubair Ahmed, Professor of Neuroscience at the University of Birmingham. Zubair oversees the laboratory procedures of the study, like genetic analysis of samples.
- Dr Valentina Pietro, Molecular Neuroscience Fellow at the University of Birmingham. Valentina works with Jon Hazeldine and Zubair on the genetic analysis of samples.
- Dr Jon Hazeldine, Postdoctoral Research Fellow at the University of Birmingham. Jon works with Zubair and Valentina on the genetic analysis of samples.
- Dr Laura Nice, Patient and Public Involvement Manager at the University of Birmingham. Laura leads the patient and public involvement (PPI) activities of GHoSt, working with Linda to make sure that the needs and perspectives of people affected by stroke are at the heart of GHoSt.
- Linda Thompson, the team's PPI representative. Linda works with Laura, using her personal experience of stroke to guide the progress of the project.
- Dr Jon Bishop, Senior Trial Statistician at the University of Birmingham. Jon is responsible for the statistical analyses for GHoSt.
The team are also supported by multiple research paramedics and research nurses in the Birmingham area who recruit and follow up with participants, as well as project support officers who deal with the administrative aspects of GHoSt.