Introduction: Globally, 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 methods: A 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.
Results: Of 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.
Conclusion: Rural 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.
Keywords: Geography; Mortality; Patient outcomes; Review; Trauma systems; Wounds and injuries.
Copyright © 2019 Elsevier Ltd. All rights reserved.
Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the U.S. Preventive Services Task Force [Internet].Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Sep. Report No.: 18-05239-EF-1. Agency for Healthcare Research and Quality (US). 2018. PMID: 30354042 Free Books & Documents. Review.
The impact of pre-injury anticoagulation therapy in the older adult patient experiencing a traumatic brain injury: A systematic review.JBI Libr Syst Rev. 2012;10(58):4610-4621. doi: 10.11124/jbisrir-2012-429. JBI Libr Syst Rev. 2012. PMID: 27820526
Interventions to Prevent Falls in Community-Dwelling Older Adults: A Systematic Review for the U.S. Preventive Services Task Force [Internet].Rockville (MD): Agency for Healthcare Research and Quality (US); 2018 Apr. Report No.: 17-05232-EF-1. Agency for Healthcare Research and Quality (US). 2018. PMID: 30234932 Free Books & Documents. Review.
Association between pacifier use and breast-feeding, sudden infant death syndrome, infection and dental malocclusion.JBI Libr Syst Rev. 2005;3(6):1-33. doi: 10.11124/01938924-200503060-00001. JBI Libr Syst Rev. 2005. PMID: 27819973
Community-based care for the specialized management of heart failure: an evidence-based analysis.Ont Health Technol Assess Ser. 2009;9(17):1-42. Epub 2009 Nov 1. Ont Health Technol Assess Ser. 2009. PMID: 23074521 Free PMC article.