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SVIN MT2020 + GLOBAL MECHANICAL THROMBECTOMY ACCESS SCORE
Abstract
Background and Aims
Access to emergent mechanical thrombectomy (MT) for acute ischemic stroke with large vessel occlusions is limited worldwide with vast disparities between countries. MT2020+, a global initiative of SVIN, aimed to create a global MT access score using systematic, mixed methods approach performed to objectively measure the drivers of access needed to accelerate treatment worldwide.
Methods
Four independent investigators performed an in-depth systematic literature review using the Peer Review of Electronic Search Strategies. Access drivers were identified and categorized into 3 groups: information and diagnostic access, physical access and financial access. A multispecialty international expert panel was created and scored each attribute using a modified Delphi process with assistance of University of Calgary W21C. A 1–9-point scale was used, with 1 being not at all important and 9 being extremely important, followed by virtual face to face meeting to deliberate attributes whose mean fell between 4-6.
Results
After initial screening of 2864 abstracts, 523 studies were included in the final systematic review. A total of 34 possible attributes that drive access were identified. After the modified Delphi process, 26 individual attributes were determined to be of significance in the creation of a MT access score. 5 attributes were related to financial access, 11 were related to physical access and 10 were information and diagnostic drivers of access.
Conclusions
The global MT access score represents a tool to evaluate MT access barriers in different world regions. Weighting of the individual attributes and validation of the score will be needed prior to its implementation.