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Table 2 Summary of key results on changes in travel distance/time and mortality following UEC service reconfiguration

From: Effects of service changes affecting distance/time to access urgent and emergency care facilities on patient outcomes: a systematic review

Study ID

Population

Comparison

Reported change in travel distance/time

Reported effect on mortality

Hsia 2012 [10]

General UEC

Increased distance vs. no change

Median 0.8 miles (range 0.1 to 33.4)

OR 1.04 (95% CI 0.99 to 1.09)

Mustonen 2017 [12]

General UEC

ED closure vs. site with no closure

Not reported

No increase in any age group

Knowles 2018 [3]

General UEC

ED closure vs. control site with no closure; before vs. after closure within sites; sub-areas at each site with above vs. below median change in travel time

Increased travel time range by site: 0–19, 0–22, 0–14, 0–23 and 0–25 min

No statistically reliable evidence to suggest a change in the number of deaths following an ED closure in any site or on average across all sites

Avdic 2016 [6]

Acute MI

ED closure vs. sites with no closure

Median 13 km

Mean difference in survival to discharge 0.015 (72.4 vs. 74.9%)

Shen 2012 [14]

Acute MI

Increased travel time vs. no change

No change 89.2%; < 10 min 8.9%; 10–30 min 1.7%; > 30 min 0.2%

Increase in mortality rate for those with > 30 min increase: 1.72 percentage points at 7 days, 1.23 at 30 days, 2.58 at 90 days, 4.49 at 180 days and 5.65 at 1 year

Shen 2016 [15]

Acute MI

Increased travel time vs. no change

Categories as Shen 2012

Increase in mortality rate for those with > 30 min increase: 6.58 percentage points (95% CI 2.49 to 10.68) at 90 days and 6.52 (95% CI 1.69 to 11.35) at 1 year. Significant but less pronounced effect for 10–30 min increase, no effect for < 10 min

Hsia 2014 [11]

Trauma

Increased travel time vs. no increase (no change or decrease)

Average travel time to the nearest trauma centre was 47 min (interquartile range, 27–52) for patients who experienced an increase in travel time and 34 min (interquartile range, 23–35) for those who did not

OR for in-patient mortality 1.21 (95% CI 1.04 to 1.4) overall and 1.29 (95% CI 1.11 to 1.51) during the first 2 years after a closure

Yaghoubian 2008 [16]

Trauma

Before vs. after trauma centre closure

Median transport time 12 (interquartile range 8–17) vs. 13 (9–17) minutes

Mortality rate increased from 5.4 to 7.3% but was lower in the later period after adjusting for severity score (OR 0.69, 95% CI 0.49 to 0.97)

Combier 2013 [7]

Maternity

Before vs. after maternity unit closures

Mean time was estimated at 21 min in 2000 and at 24 min in 2009, while maximum time increased from 61 to 72 min

No significant association between travel time and stillbirth or perinatal mortality at any time point