Impact of geographical location on ICU outcomes in adults: a scoping review

Information from the abstract

OBJECTIVES: Rural populations experience poorer health outcomes than urban counterparts globally. Limited studies have examined the impact of geographical location-specifically travel distance/time and rurality-on intensive care unit (ICU) outcomes. This scoping review aimed to map literature on geographical location and ICU outcomes to better inform policy and improve ICU access in underserved communities. DESIGN: Scoping review. DATA SOURCES: MEDLINE, CINAHL and Embase were searched through to 8 May 2025. Grey literature was identified through ProQuest Dissertations and Theses Global, including dissertations, theses and conference proceedings. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies examining the impact of geographical location (rurality and/or travel distance/time) on ICU outcomes in adult populations were included. No restrictions were placed on country, healthcare setting or date of publication. Peer-reviewed primary studies and grey literature were eligible; editorials, commentaries and reviews were excluded. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted study characteristics, rurality definitions, travel distance/time measures and ICU outcomes using a standardised form and synthesised descriptively. RESULTS: 23 articles and 1 conference abstract; all were retrospective studies. 23 studies reported on rurality with 20 specifying the definition used. Six studies reported travel distance/time, all detailing measurement methods. 12 studies mentioned baseline patient comorbidities, 18 reported ICU admissions and 4 hospital/ICU readmissions. More studies reported longer ICU length of stay and greater ICU intervention use among rural compared with urban/metropolitan patients, although mortality findings were inconsistent. Heterogeneity limited direct comparison. No clear association was found between travel distance/time and ICU outcomes. CONCLUSIONS: Inconsistent rurality definitions complicated comparisons. The mapped literature reported longer ICU LOS and greater intervention use for rural compared with urban/metropolitan patients; however, mortality findings were inconsistent with no predictive pattern. No clear association was observed between travel distance/time and ICU outcomes. Future research should adopt standardised rurality definitions, account for preadmission health status and focus on condition specific contexts to inform policy.

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Related topics: Trauma and Emergency Care Studies · Intensive Care Unit Cognitive Disorders · Sepsis Diagnosis and Treatment