Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy

医学 系统回顾 心理干预 德尔菲法 冲程(发动机) 医疗急救 急诊科 紧急医疗服务 梅德林 急诊医学 护理部 人工智能 计算机科学 机械工程 工程类 政治学 法学
作者
Sushanth Aroor,Cynthia Zevallos,Kaiz Asif,Nishita Singh,Jennifer Potter‐Vig,Aarón Rodríguez-Calienes,Bijoy K. Menon,Aravind Ganesh,Jeffrey L. Saver,Hooman Kamel,Anne W. Alexandrov,Edward C. Jauch,Zhongrong Miao,Xiaochuan Huo,Pankajavalli Ramakrishnan,Shashvat M. Desai,Kaustubh Limaye,Mohammad El‐Ghanem,Gábor Tóth,Chethan Venkatasubba Rao
出处
期刊:Stroke [Lippincott Williams & Wilkins]
被引量:2
标识
DOI:10.1161/strokeaha.124.047805
摘要

BACKGROUND: The availability of mechanical thrombectomy (MT) for acute ischemic stroke is limited, and vast disparities exist between countries. We aim to create a MT access score to measure the drivers of access to help quantify and accelerate treatment worldwide. METHODS: We used a systematic review complemented by a modified Delphi method. In the first of 3 rounds, 4 independent investigators performed a systematic literature review using key search terms that drive MT access, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the second round, a panel of 6 anonymous international experts selected key attributes needed for scoring. In the final round, a total of 12 attributes were selected on consensus, each given a score on a 0 to 3 scale. An ultimate MT access score (range, 0–36) was proposed as a new tool to use in identifying barriers to MT access and assist in providing an initial framework for public health interventions. RESULTS: Of 2864 abstracts screened, 121 studies were included in the final systematic review. A total of 34 attributes that potentially drive MT access were initially identified. In the final round, 12 attributes were selected by the expert panel: public awareness, emergency medical services transportation, prehospital large vessel occlusion screening, interhospital transfer policy, emergency department protocols, stroke imaging protocols, emergency department stroke expertise or telestroke availability, interventionalists, MT-capable centers, device availability, and insurance coverage. These attributes were weighted as part of the final score of 0 to 36. CONCLUSIONS: The MT access score represents the first tool to quantify barriers to global MT access. Its implementation stands not just as an academic achievement but as a beacon of hope for improving stroke care and outcomes worldwide, bringing us a step closer to bridging the gap in stroke treatment disparities.
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