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Introduction Subdural hematomas (SDH) are an increasingly common neurosurgical emergency, particularly in aging populations. Non-contrast CT (NCCT) is the diagnostic standard for all types of SDH, and timely SDH detection is critical for adequate care. RAPID SDH (iSchemaView, Menlo Park, CA) is an FDA-cleared, fully automated artificial intelligence platform designed to detect SDH on NCCT. We evaluated the diagnostic performance of RAPID SDH compared to expert neuroradiologist consensus for SDH detection.Methods We conducted a retrospective, multi-center validation study of patients with suspected SDH on NCCT imaging. Two blinded neuroradiologists independently assessed each de-identified scan for SDH presence, discrepancies were adjudicated by a third blinded neuroradiologist to establish ground truth. SDH subtype (acute, chronic, mixed), laterality, and associated findings were recorded by the neuroradiologists. NCCT studies were processed by RAPID SDH, and the same variables were collected for comparative analysis. Primary outcome was accurate SDH detection by RAPID compared with the ground truth. Subgroup analyses evaluated performance by SDH subtype and laterality.Results A total of 310 NCCT scans from 14 sites met inclusion criteria following exclusion of three cases for low volume or poor image quality. 186 patients were male (60%), mean age was 63 (SD: 22). Ground truth established 157 positive cases of SDH (48 acute, 47 chronic, 62 mixed), and 153 negatives. RAPID SDH demonstrated overall sensitivity of 92.4% (95% CI: 87.1-95.6) and specificity of 98.7% (95% CI: 95.4-99.6) for SDH detection. Sensitivity by subtype was 87.5% for acute SDH, 91.5% for chronic SDH, and 96.8% for mixed SDH. Performance remained high for bilateral SDH with a sensitivity of 93.2% (95% Cl: 83.8-97.3).Conclusion In conclusion, RAPID SDH demonstrated excellent sensitivity and specificity for detection of all types of SDH on NCCT, supporting its role as a reliable adjunct to neuroradiologist interpretation with the potential for expedite timely diagnosis and management in patients with subdural hematomas.Disclosures S. Snyder: None. K. Copeland: None. H. Haerian: None.Abstract E-341 Figure 1