Rural Computed Tomography - a model for access to rapid stroke care in sparsely populated areas?

Patients living in rural districts may have limited access to acute stroke treatment due to long transport times to hospital facilities with radiology and revascularization therapy. This study simulates the utility of transferring acute diagnostics and treatment into rural areas by deployment of rural Computed Tomography (CT) services. In Hallingdal county, Norway, a CT and thrombolytic station is operated in a local medical centre. We hypothetically deployed similar stations in rural Norway to explore the impact of such model of prehospital rural acute stroke treatment on ambulance transport times and patient outcomes after ischemic stroke. In addition, we described consequent changes in transport strategy for patients with suspected Large Vessel Occlusion (LVO) stroke. Significant reductions in hypothetical transport times were obtained after deployment of 30 rural CT stations. The part of the Norwegian population not eligible for thrombolysis within the recommended time window due to long transport time decreased from 11% to 1% (p< 0.001). By simulation of 1000 ischemic strokes, the estimated odds ratio for good outcome judged by modified Rankin Scale after thrombolysis for the rural population increased from 1.37 to 1.61 (p < 0.001). When LVO stroke was suspected, rural CT stations slightly increased the geographical area in which patients would receive local thrombolysis before transport to endovascular treatment. Deployment of rural CT stations may facilitate rapid triage and early thrombolysis for patients with acute ischemic stroke living furthest away from hospital and this concept may be applicable to other health care systems worldwide. However, further research is needed to confirm its utility in the clinical setting.