Transcranial ultrasound for prehospital stroke assessment

• Research type

  Research Study

• Full title

  Designing a prehospital scoring system for the prediction of haemorrhagic stroke and ischaemic stroke.

• IRAS ID

  204829

• Contact name

  Ashish Stephen Macaden

• Contact email

  Ashish.MacAden@nhs.net

• Sponsor organisation

  NHS Highland

• Duration of Study in the UK

  3 years, 0 months, 2 days

• Research summary

  BACKGROUND: Few stroke patients receive rapid clot-busting injections (thrombolysis) because they can only be given safely and effectively within a time limit of 4.5 hours, following imaging to exclude bleeding in the brain. Rapid assessment of suspected stroke using clinical features combined with remotely supported ultrasound scans of the brain through the skull (transcranial ultrasound) could potentially allow earlier intervention.
  
  AIM: to design a prehospital scoring system aiming to differentiate between strokes caused by bleeding versus strokes caused by blood clots blocking the arteries, for use either in ambulances or early after hospital admission. Also to assess the utility of Doppler ultrasound in detecting middle cerebral artery occlusion.

  METHODS: Approximately 500 consecutive patients with suspected stroke will be recruited. Demographic data, time of symptom onset, nature of symptoms and National Institute of Health Stroke Scale (NIHSS) data will be gathered at patient's admission. Brain imaging by CT will be conducted. A transcranial ultrasound scan will be performed as soon as possible after admission. Stored images will be reviewed for: 1) image quality; 2) presence of both main arteries taking blood to the brain (using Doppler imaging, which produces colour ultrasound images showing blood flow); 3) visible blood; and 4) anatomical signs that the presence of blood has shifted structures in the brain.

  EXPECTED OUTCOMES: Predictive models and a scoring system for strokes caused by bleeding or blocked arteries will be generated using clinical and ultrasound findings. Sensitivity and specificity of the scoring system will be assessed using an array of statistical techniques. If the scoring system is sufficiently accurate, this would set the scene for a future trial of prehospital thrombolysis for stroke.

• REC name

  Scotland A: Adults with Incapacity only

• REC reference

  17/SS/0046

• Date of REC Opinion

  2 May 2017

• REC opinion

  Further Information Favourable Opinion