(788) Geographic Access to Pediatric Intensive Care in the U.S. in the 21st Century

Introduction: More than a quarter million children are hospitalized in intensive care units (ICUs) each year. Pediatric ICUs (PICUs) are specialized ICUs that provide for unique care needs of children, which includes pediatric specialists, family-centered care models, and pediatric-specific resources. Over the past 40 years there have been an increase in number of PICUs and PICU beds. The largest increase in PICUs was 43% between 1979 and 1988 when the specialty was further defined. This slowed in the late 1990s, and there was a decrease in PICUs over the next 15 years.
Although the characteristics of PICUs has been well-described, the change in location of PICUs over time is an important factor in the ease of access for critically ill children. For various reasons, a multitude of units have opened, closed, or moved over the last few decades, thereby affecting the distance a child must travel to access a PICU. Geographic access to PICUs is also essential to understanding the inequities that affect the survival and outcomes of children who present to community hospitals.
For this study, we conducted a geospatial analysis to analyze the change in distribution of PICUs across the United States over the past 22 years.

Methods: Lists of PICUs were used from three different years (2001, 2016 and 2023). These lists were compiled from multiple sources. PICUs included in analysis were limited to those in the contiguous United States. We used straight-line distances of PICUs, and the closest location was selected using the shortest, geodesic straight-line distance. Polygons were created around each PICU location to indicate all locations within a given polygon are closer to the PICU inside that polygon than any other PICU location. Maps were generated using ArcGIS Pro software.

Results: The minimum distance between PICUs was 0 miles for all years, and the maximum distance increased from 866 miles to 928 miles at the first time interval. The median distance did not vary significantly with an increase from 12.5 (IQR 4.5, 37.1) to 12.8 (IQR 4.9, 36.2) to 13.3 (IQR 5.2, 36.0) miles for 2001, 2016, and 2023, respectively.

Conclusions: By observing and mapping PICU locations, governments and healthcare systems can better anticipate needs and ensure that all children have access to life-saving critical care.