Purines for Rapid Identifcation of Stroke MImics (PRISM)

中风是全球第二大死亡原因，也是西方世界成人残疾的最常见原因。它造成了巨大的健康和社会保健负担，超过了心脏病，包括每年55亿英镑的治疗费用（占NHS预算的5%）和每年50亿英镑的护理费用和收入损失的经济影响。有强有力的证据表明，即使是诊断准确性和治疗速度方面的微小改进，也会为人口健康带来巨大收益，并大大降低护理成本。当中风是由动脉阻塞引起时，影响最大（85%），因为更快，更好地恢复的机会与患者使用凝块破坏药物（4.5小时内溶栓）或手术凝块清除（6小时内大动脉血栓切除术）治疗的速度直接相关。即使不适合这些治疗之一，所有患者都可以从集中的专家超急性卒中单元（HASU）中受益，这通常涉及绕过当地的A&E。救护车服务负责初步识别可能由中风引起的症状。然而，对于非专科医生来说，在最初的几个关键小时内正确诊断是一个具有挑战性的条件，并且许多其他条件具有与中风相同的症状，导致“模仿”患者进入中风治疗途径。因此，误诊率很高：30%的中风患者在A&E中未被识别; 50%的疑似中风患者被护理人员发现患有模拟疾病;高达17%的接受溶栓治疗（一种昂贵且有潜在危险的治疗）的患者没有中风。模拟条件也是有限资源的主要负担;与标准医院病床相比，NHS HASU每年治疗约13，500名模拟患者，额外费用为3100万英镑。准确识别救护车和A&E部门中的中风和模拟患者将改善患者的预后，并更好地利用有限的专家资源。Sarissa Biomedical正在与研究人员和NHS服务部门合作，开发一种简单的床旁诊断血液测试（SMARTChip），用于测量血液嘌呤水平。医院的研究表明，这些是中风的极早期指标。由于大多数转介到HASU是通过救护车，开发用于护理人员的SMARTChip将有助于正确诊断中风，并显着减少被不适当地引导到HASU的患者数量。这将确保为中风保留专家资源，并使模拟患者能够在更合适的当地环境中进行评估。嘌呤水平与卒中严重程度相关，并迅速为临床医生提供额外信息，以优化治疗决策（即遵循溶栓和/或血栓切除术途径）。该项目的第一阶段证实，SMARTChip将受到临床医生的重视，并可部署在NHS服务中，预计每年可节省超过2500万英镑。第2阶段将通过提供患者和服务受益、运营可行性和积极经济影响的证据，寻求监管部门的批准和对常规临床使用的调试支持。

Stroke is the 2nd leading cause of death worldwide and the commonest cause of adult disability in the western world. It is responsible for a huge health and social care burden which exceeds heart disease, including £5.5bn/year for treatment (5% of the NHS budget) and £5bn/year economic impact for care costs and lost earnings. Powerful evidence exists that even small improvements in the accuracy of diagnosis and the speed of treatment produce large gains for population health and greatly reduced care costs. The impact is greatest when stroke is caused by an arterial blockage (85%), as the chance of a faster, better recovery is directly related to how quickly patients are treated with a clot busting drug (thrombolysis within 4.5 hours) or surgical clot removal (thrombectomy within 6 hours for large arteries). Even when unsuitable for one of these treatments, all patients benefit from admission to a centralised specialist Hyperacute Stroke Unit (HASU), which often involves bypassing a local A&E. Ambulance services are responsible for the initial recognition of symptoms that might be due to stroke. However, it is a challenging condition for non-specialists to diagnose correctly in the first few critical hours, and a number of other conditions have the same symptoms as stroke, resulting in “mimics” patients entering the stroke treatment pathway. As a result, there is a high degree of misdiagnosis: 30% of stroke patients go unrecognised in A&E; 50% of suspected stroke patients identified by paramedics turn out to have mimic conditionss; and up to 17% of patients receiving thrombolysis (an expensive and potentially hazardous treatment) have not had a stroke. Mimic conditionss are also a major burden on limited resources; around 13,500 mimic patientss annually are treated by NHS HASUs at an additional cost of £31m compared to a standard hospital bed. Accurate identification of stroke and mimic patients in ambulances and A&E departments would lead to improved patient outcomes and better use of limited specialist resources. Sarissa Biomedical is working with researchers and NHS services to develop a simple Point of Care Diagnostic blood test (SMARTChip) which measures blood purine levels. Studies in hospital have shown that these are an extremely early indicator of stroke. As the majority of referrals to HASU are via ambulance, developing SMARTChip for paramedic use would assist in the correct diganosis of stroke and significantly reduce the number of patients being inappropriately directed to HASUs. This would ensure that specialist resources are reserved for stroke and enable mimics patients to be assessed in a more appropriate local setting. The purine levels correlate with stroke severity and rapidly provides clinicians with additional information to optimise treatment decisions (i.e. to follow a thrombolysis and/or thrombectomy pathway). Phase 1 of this project confirmed that SMARTChip would be valued by clinicians and could be deployed in NHS services with a projected saving of over £25 million annually. Phase 2 will seek regulatory approval and commissioning support for routine clinical use by generating evidence of patient and service benefits, operational feasibility and positive economic impact.