Abstract 272: Essential Requirements to Develop Stroke Thrombectomy Program in Limited Resource Settings: A Modified Delphi Survey
Notice bibliographique
Résumé
Introduction Mechanical thrombectomy (MT) has revolutionized care for patients with ischemic strokes from large vessel occlusion (LVO) leading to adoption as the standard of care. However, the Mechanical Thrombectomy Global Access For Stroke (MT‐GLASS) study, demonstrated that global access to mechanical thrombectomy is <3% of the demand. One possible reason for these shortcomings are the significant resources required to develop a sustainable MT service. Our aim is to understand what infrastructure, equipment and staff are essential to perform safe and effective MT for LVO‐stroke in resource limited settings. Methods Using a modified Delphi method iterative rounds of surveys were administered to an international panel of stroke leaders. Initial survey questions covered optimal and minimal requirements for diagnosis, imaging, equipment, and staff to perform MT. Results from the initial survey underwent qualitative analysis to create statements identifying essential requirements for a stroke thrombectomy program in resource‐limited setting. These statements were distributed in follow up surveys with participants rating their level of agreement with each statement using a 5‐point Likert scale. Consensus was defined as 70‐100% of respondents agreeing (Likert scale levels strongly agree and agree) or disagreeing (Likert scale levels disagree and strongly disagree) with the statement. Results A total of 27 experts answered the initial 40‐question survey. Experts from various specialties including neurosurgery, neurointervention, and vascular neurology, with majority (63%) from an academic center (63%) across 18 countries participated. Experts uniformly agreed that it is possible to develop a stroke thrombectomy program in a resource‐limited setting though barriers would include cost, public awareness of stroke symptoms, and developing an emergency triage protocol to efficiently identify and image potential MT candidates. 86% of respondents agreed that interventionalists are the appropriate provider to identify candidates for MT. There was disagreement on minimum necessary imaging required to identify a candidate for MT with the most common answer of CT head and CTA (54%) not meeting consensus definition. Essential equipment to perform MT that achieved consensus included (% agreement) access sheath (92%), guide catheter (100%), glidewire (100%), aspiration catheter (100%), aspiration syringe (92%), microcatheter and microwire (85%). Other listed equipment did not achieve consensus as essential equipment including ultrasound for access (8%), diagnostic catheter (69%), aspiration pump (23%), stent retriever (69%), extracranial stent (69%), intracranial stent (54%), and coils (54%). Experts agreed that access to common femoral artery can be safely obtained through palpation alone (76% agree) and that closure devices are not necessary as manual pressure will suffice (76% agree). Example of area lacking consensus is the necessity of invasive blood pressure monitoring follow MT (54% agree it is necessary, 30% disagree, 16% indifferent). Conclusions We have demonstrated that a strong consensus exists among experts that it is possible to create a MT program in a limited resource setting. While country specific barriers need to be addressed, the essential requirements for development of these programs were identified. We believe that these results can serve as a blueprint for development of national stroke programs which include MT.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,026 | 0,029 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».