Introduction Viz.ai is a mobile triage tool for rapid identification and transfer of cerebrovascular emergencies. Viz.ai facilitates interhospital communication and data tracking. Our Comprehensive Stroke Center (CSC), located in a metropolitan area, interacts with many Viz.ai spoke hospitals in both metropolitan and rural areas of our state. There are known health disparities in rural communities throughout the United States. Using data from Viz.ai, we aimed to evaluate incidence of stroke activations and thrombectomy activations, comparing referring Primary Stroke Centers from rural and metropolitan communities.

Methods Beginning in 2020, we utilized Viz.ai to triage stroke patients from the Primary Stroke Centers (PSCs) that refer complex stroke patients only to our CSC. Using data collected from January, 2022 to February, 2023, we evaluated the number of stroke activations (CT-angiograms performed to evaluate for stroke), and the number of thrombectomy alerts (artificial intelligence alert on Viz.ai). Using 2020 Census data, we calculated the ‘at-risk’ population for each referring hospitals as the total population of the hospital’s county and the counties immediate adjacent to them. We calculated and compared annualized per capita incidences of stroke activations and thrombectomy activations, comparing metropolitan to rural communities.

Results During the study period, the metropolitan PSC had 298 stroke activations and 29 thrombectomy activations with an at-risk population of 192,644. One rural PSCs had 552 stroke activations, 38 thrombectomy alerts, with an at-risk population of 259,365, while the other had 501 stroke activations, 34 thrombectomy alerts, and an at-risk population of 199,744. Accounting for annualization and population density, this yielded a per capita incidence of stroke activation at the metropolitan PSC of 143 per 100,000, compared to an incidence at the rural PSCs of 232 per 100,000 and 234 per 100,000; compared to the metropolitan PSC, incidence of activations at the rural PSCs were both significantly higher (p<0.0001). The annualized per capita incidence of thrombectomy alerts was 3.4 per 100,000 at the metropolitan center, compared to 8.0 per 100,000 at one rural PSC and 4.6 per 100,000 at the other rural PSC. These trended toward but did not reach statistically significant differences (p 0.06 and 0.68 respective).

Conclusion Compared to a metropolitan PSC in our network, two rural PSCs had significantly higher per capita incidence of stroke activations. There was a trend toward higher per capita thrombectomy alerts as well. Given the known health disparities in rural regions of the US, these findings provide clear confirmation of the importance of stroke care protocols in rural areas, and the value of rapid identification and triage for rural communities. Our future studies will examine more detailed patient-specific factors based on geographic region.

Disclosures J. Fraser: None. J. Frank: None. A. Chen: None. M. Campbell: None. L. Wise: None. B. Krein: None. R. Silvernail: None. D. Dornbos: None. S. Pahwa: None. J. Lee: None.