The relationship between geographic location and outcomes following injury: A scoping review |
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| Affiliation: | 1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;2. Physiotherapy Department, Epworth Hospital, Melbourne, Australia;1. Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States;2. Department of Epidemiology, Dartmouth College, Hanover, NH, United States;3. Quantitative Biomedical Sciences, Dartmouth College, Hanover, NH, United States;1. London Health Sciences Center, Canada;2. University of Southern California, United States;1. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway;2. Department of Clinical Medicine, University of Bergen, Bergen, Norway;1. Department of Orthopaedics and Traumatology, Trauma Unit, Helsinki University Hospital and University of Helsinki, Finland;2. Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany |
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| Abstract: | IntroductionGlobally, injury incidence and injury-fatality rates are higher in regional and remote areas. Recovery following serious injury is complex and requires a multi-disciplinary approach to management and community re-integration to optimise outcomes. A significant knowledge gap exists in understanding the regional variations in hospital and post-discharge outcomes following serious injury. The aim of this study was to review the evidence exploring the association between the geographic location, including both location of the event and place of residence, and outcomes following injury.Materials and MethodsA scoping review was used to investigate this topic and provide insight into geographic variation in outcomes following traumatic injury. Seven electronic databases and reference lists of relevant articles were searched from inception to October 2018. Studies were included if they measured injury-related mortality, outcomes associated with hospital admission, post-injury physical or psychological function and analysed these outcomes in relation to geographic location.ResultsOf the 2,213 studies identified, 47 studies were included revealing three key groups of outcomes: mortality (n = 35), other in-hospital outcomes (n = 8); and recovery-focused outcomes (n = 12). A variety of measures were used to classify rurality across studies with inconsistent definitions of rurality/remoteness. Of the studies reporting injury-related mortality, findings suggest that there is a greater risk of fatality in rural areas overall and in the pre-hospital phase. For those patients that survived to hospital, the majority of studies included identified no difference in mortality between rural and urban patient groups. In the small number of studies that reported other in-hospital and recovery outcomes no consistent trends were identified.ConclusionRural patients had a higher overall and pre-hospital mortality following injury. However, once admitted to hospital, there was no significant difference in mortality. Inconsistencies were noted across measures of rurality measures highlighting the need for more specific and consistent international classification methods. Given the paucity of data on the impact of geography on non-mortality outcomes, there is a clear need to develop a larger evidence base on regional variation in recovery following injury to inform the optimisation of post-discharge care services. |
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| Keywords: | Geography Wounds and injuries Trauma systems Mortality Patient outcomes Review |
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