Analysing geospatial variables in the context of trauma networks: A scoping review

Trauma is a leading cause of preventable death and disability worldwide. Although nearly 90% of trauma-related mortality occurs in low- and middle-income countries, current reports on emergency medical care often come from high-income countries with fewer resource constraints. This scoping review investigates which geospatial variables are measured and reported in trauma networks, how they are defined, characteristics of relevant studies, analytical software used, and existing gaps in the literature.

A search was conducted using PubMed, Embase, and Cochrane for studies published between 2004 and 2024. Data extracted included study characteristics, geospatial variables including prehospital time and distance, spatial access, transport modality, population measures, injury location, analytical methods, and patient outcomes such as mortality and injury severity. Descriptive analysis was performed, grouping studies according to key geospatial themes.

A total of 13,908 studies were identified, of which 41 were included, spanning seventeen countries. Prehospital time was reported by nineteen studies where longer prehospital intervals, including delays in dispatch and transport, were consistently associated with worse outcomes. Fifteen studies evaluated patients beyond golden hour access to care, demonstrating increased prehospital mortality with longer transport distances, lower population densities, and limited infrastructure. Rural populations experienced reduced access and higher mortality; HEMS expanded access and was associated with improved survival. Key gaps included variations in geospatial variable definitions, limited integration of dynamic factors such as infrastructure and traffic, inconsistent reporting of location data, and unclear criteria for HEMS utilisation.

Geospatial variables are strongly associated with trauma system performance where shorter prehospital times and improved spatial access were linked to reduced mortality. Standardised geospatial measures, clear transport modality guidelines, and regionally appropriate trauma network design are needed to reduce geographic inequalities and optimise patient outcomes.