{"paper_id":"29c8ae98-a425-4bcd-b319-70d60af00935","body_text":"Rural Computed Tomography - a model for access to rapid stroke care in sparsely populated areas? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Rural Computed Tomography - a model for access to rapid stroke care in sparsely populated areas? Jørgen Ibsen, Maren Ranhoff Hov, Jessalyn Kathryn Holodinsky, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7742574/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Mar, 2026 Read the published version in BMC Health Services Research → Version 1 posted 13 You are reading this latest preprint version Abstract Background 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. Methods 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. Results 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. Conclusions 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. stroke computed tomography thrombolysis prehospital rural Full Text Additional Declarations Competing interest reported. Dr. Holodinsky reports equity ownership in DESTINE Health Inc. Supplementary Files Supplementaryfile.docx Cite Share Download PDF Status: Published Journal Publication published 19 Mar, 2026 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 07 Jan, 2026 Reviews received at journal 16 Nov, 2025 Reviews received at journal 09 Nov, 2025 Reviews received at journal 08 Nov, 2025 Reviewers agreed at journal 07 Nov, 2025 Reviewers agreed at journal 03 Nov, 2025 Reviewers agreed at journal 02 Nov, 2025 Reviewers agreed at journal 31 Oct, 2025 Reviewers invited by journal 31 Oct, 2025 Editor assigned by journal 29 Oct, 2025 Editor invited by journal 07 Oct, 2025 Submission checks completed at journal 06 Oct, 2025 First submitted to journal 06 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Dr. Holodinsky reports equity ownership in DESTINE Health Inc.\",\"formattedTitle\":\"Rural Computed Tomography - a model for access to rapid stroke care in sparsely populated areas?\",\"fulltext\":[],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":false,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":true,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":true,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-health-services-research\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bhsr\",\"sideBox\":\"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/BHSR/default.aspx\",\"title\":\"BMC Health Services Research\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"stroke, computed tomography, thrombolysis, prehospital, rural\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7742574/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7742574/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003ePatients 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.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eIn 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.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eSignificant 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\\u0026thinsp;\\u0026lt;\\u0026thinsp;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\\u0026thinsp;\\u0026lt;\\u0026thinsp;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.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003eDeployment 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.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Rural Computed Tomography - a model for access to rapid stroke care in sparsely populated areas?\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-11-11 14:28:37\",\"doi\":\"10.21203/rs.3.rs-7742574/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-01-07T07:22:33+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-17T00:38:25+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-09T17:44:04+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-08T16:27:47+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"132710333207276930988024693118358241631\",\"date\":\"2025-11-07T10:21:43+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"320977870573220836378473823927817740618\",\"date\":\"2025-11-03T16:43:47+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"278629056715488785863223064173791460478\",\"date\":\"2025-11-02T08:07:30+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"303720207449872353338486587293294613656\",\"date\":\"2025-10-31T13:19:53+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-10-31T08:02:24+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-10-29T17:28:14+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-10-07T10:21:30+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-10-06T12:54:13+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Health Services Research\",\"date\":\"2025-10-06T12:50:23+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-health-services-research\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bhsr\",\"sideBox\":\"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/BHSR/default.aspx\",\"title\":\"BMC Health Services Research\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"2c953f77-334a-4aed-97dd-588b3fb2c06f\",\"owner\":[],\"postedDate\":\"November 11th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-03-23T16:15:35+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7742574\",\"link\":\"https://doi.org/10.1186/s12913-026-14307-6\",\"journal\":{\"identity\":\"bmc-health-services-research\",\"isVorOnly\":false,\"title\":\"BMC Health Services Research\"},\"publishedOn\":\"2026-03-19 15:59:27\",\"publishedOnDateReadable\":\"March 19th, 2026\"},\"versionCreatedAt\":\"2025-11-11 14:28:37\",\"video\":\"\",\"vorDoi\":\"10.1186/s12913-026-14307-6\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12913-026-14307-6\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7742574\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7742574\",\"identity\":\"rs-7742574\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}