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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 IDPopulationComparisonReported change in travel distance/timeReported effect on mortality
Hsia 2012 [10]General UECIncreased distance vs. no changeMedian 0.8 miles (range 0.1 to 33.4)OR 1.04 (95% CI 0.99 to 1.09)
Mustonen 2017 [12]General UECED closure vs. site with no closureNot reportedNo increase in any age group
Knowles 2018 [3]General UECED 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 timeIncreased travel time range by site: 0–19, 0–22, 0–14, 0–23 and 0–25 minNo 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 MIED closure vs. sites with no closureMedian 13 kmMean difference in survival to discharge 0.015 (72.4 vs. 74.9%)
Shen 2012 [14]Acute MIIncreased travel time vs. no changeNo 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 MIIncreased travel time vs. no changeCategories as Shen 2012Increase 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]TraumaIncreased 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 notOR 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]TraumaBefore vs. after trauma centre closureMedian transport time 12 (interquartile range 8–17) vs. 13 (9–17) minutesMortality 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]MaternityBefore vs. after maternity unit closuresMean time was estimated at 21 min in 2000 and at 24 min in 2009, while maximum time increased from 61 to 72 minNo significant association between travel time and stillbirth or perinatal mortality at any time point