---
title: "Geographic Trends in U.S. PICU Access 2001–2023: Distances, Urban Concentration, and Regional Vari"
id: "pubmed-42644682"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42644682"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42644682/"
doi: "10.1097/PCC.0000000000004022"
published_at: "2026-08-26T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Geographic Trends in U.S. PICU Access 2001–2023: Distances, Urban Concentration, and Regional Vari
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42644682
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42644682/)
- **DOI:** [10.1097/PCC.0000000000004022](https://doi.org/10.1097%2FPCC.0000000000004022)
- **Published At:** 2026-08-26T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study analyzed temporal changes in the geographic distribution of pediatric intensive care units (**PICUs**) in the United States at three time points: 2001, 2016, and 2023. - Design was cross-sectional using geographic methods to compute distance from each U.S. census tract center to the nearest **PICU**, assess changes in distance over time, and examine changes in rates of access by census tract. - Most **PICUs** were located in **urban** areas across all years; rural census tracts were generally farther from the nearest PICU. - Median distances from census tract centers to the nearest PICU were reported as 12.5 miles (IQR 4.5–37.1) in 2001, 12.8 miles (IQR 4.9–36.2) in 2016, and 13.3 miles (IQR 5.2–36.0) in 2023, indicating slight increases in median distance over time. - Regional variation was substantial: in 2023 the Middle Atlantic division (NJ, NY, PA) had a median distance of 7.4 miles, whereas the East South Central division (AL, KY, MS, TN) had a median distance of 30.1 miles. - Coastal regions generally had shorter distances to **PICUs**, while large portions of the Mountain and Pacific divisions had greater distances and thus lower geographic access. - Certain states had highly localized PICU presence: Arkansas, Nebraska, and Oregon each had PICUs localized to a single city; Wyoming had no PICUs in any analyzed year. - The study concludes that PICU beds remain concentrated in urban centers, producing inequitable geographic access to critical pediatric care, particularly in western and rural areas of the U.S. - Authors emphasize that mapping and quantifying **geographic access** to PICUs is an essential step toward improving equitable access to life-saving pediatric critical care. - Keywords used in the article include disaster planning, geospatial, inpatient pediatrics, pediatric intensive care unit, and rural healthcare.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Temporal Trends in Geographic Distribution of PICUs in the United States 2001-2023 [Eleanor Gradidge](https://pubmed.ncbi.nlm.nih.gov/?term=Gradidge+E&cauthor_id=42644682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#full-view-affiliation-1 "Department of Pediatrics, Division of Pediatric Critical Care, Children's Health Research Institute, University of Nebraska Medical Center, Children's Nebraska, Omaha, NE."), [Abigail Shih](https://pubmed.ncbi.nlm.nih.gov/?term=Shih+A&cauthor_id=42644682)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#full-view-affiliation-2 "University of Nebraska-Lincoln, Lincoln, NE."), [Kaeli Samson](https://pubmed.ncbi.nlm.nih.gov/?term=Samson+K&cauthor_id=42644682)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#full-view-affiliation-3 "Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE."), [Christina Cifra](https://pubmed.ncbi.nlm.nih.gov/?term=Cifra+C&cauthor_id=42644682)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#full-view-affiliation-4 "Department of Pediatrics, Division of Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA."), [Robin Klein](https://pubmed.ncbi.nlm.nih.gov/?term=Klein+R&cauthor_id=42644682)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#full-view-affiliation-5 "Department of Pediatrics, Division of Cardiology, Children's Hospital of Colorado, University of Colorado, Denver, CO."), [Adrienne G Randolph](https://pubmed.ncbi.nlm.nih.gov/?term=Randolph+AG&cauthor_id=42644682)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#full-view-affiliation-6 "Department of Anaesthesia and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#full-view-affiliation-7 "Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.") Affiliations Expand ### Affiliations * 1 Department of Pediatrics, Division of Pediatric Critical Care, Children's Health Research Institute, University of Nebraska Medical Center, Children's Nebraska, Omaha, NE. * 2 University of Nebraska-Lincoln, Lincoln, NE. * 3 Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE. * 4 Department of Pediatrics, Division of Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA. * 5 Department of Pediatrics, Division of Cardiology, Children's Hospital of Colorado, University of Colorado, Denver, CO. * 6 Department of Anaesthesia and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. * 7 Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA. * PMID: **42644682** * DOI: [ 10.1097/PCC.0000000000004022 ](https://doi.org/10.1097/pcc.0000000000004022) Item in Clipboard # Temporal Trends in Geographic Distribution of PICUs in the United States 2001-2023 Eleanor Gradidge et al. Pediatr Crit Care Med. 2026. Show details Display options Display options Format Abstract PubMed PMID Pediatr Crit Care Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Pediatr+Crit+Care+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Pediatr+Crit+Care+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42644682/) . 2026 Aug 26. doi: 10.1097/PCC.0000000000004022. Online ahead of print. ### Authors [Eleanor Gradidge](https://pubmed.ncbi.nlm.nih.gov/?term=Gradidge+E&cauthor_id=42644682)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#short-view-affiliation-1 "Department of Pediatrics, Division of Pediatric Critical Care, Children's Health Research Institute, University of Nebraska Medical Center, Children's Nebraska, Omaha, NE."), [Abigail Shih](https://pubmed.ncbi.nlm.nih.gov/?term=Shih+A&cauthor_id=42644682)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#short-view-affiliation-2 "University of Nebraska-Lincoln, Lincoln, NE."), [Kaeli Samson](https://pubmed.ncbi.nlm.nih.gov/?term=Samson+K&cauthor_id=42644682)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#short-view-affiliation-3 "Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE."), [Christina Cifra](https://pubmed.ncbi.nlm.nih.gov/?term=Cifra+C&cauthor_id=42644682)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#short-view-affiliation-4 "Department of Pediatrics, Division of Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA."), [Robin Klein](https://pubmed.ncbi.nlm.nih.gov/?term=Klein+R&cauthor_id=42644682)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#short-view-affiliation-5 "Department of Pediatrics, Division of Cardiology, Children's Hospital of Colorado, University of Colorado, Denver, CO."), [Adrienne G Randolph](https://pubmed.ncbi.nlm.nih.gov/?term=Randolph+AG&cauthor_id=42644682)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#short-view-affiliation-6 "Department of Anaesthesia and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.")[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42644682/#short-view-affiliation-7 "Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.") ### Affiliations * 1 Department of Pediatrics, Division of Pediatric Critical Care, Children's Health Research Institute, University of Nebraska Medical Center, Children's Nebraska, Omaha, NE. * 2 University of Nebraska-Lincoln, Lincoln, NE. * 3 Department of Biostatistics, University of Nebraska Medical Center, College of Public Health, Omaha, NE. * 4 Department of Pediatrics, Division of Medical Critical Care, Boston Children's Hospital, Harvard Medical School, Boston, MA. * 5 Department of Pediatrics, Division of Cardiology, Children's Hospital of Colorado, University of Colorado, Denver, CO. * 6 Department of Anaesthesia and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. * 7 Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA. * PMID: **42644682** * DOI: [ 10.1097/PCC.0000000000004022 ](https://doi.org/10.1097/pcc.0000000000004022) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objectives:** To identify and describe changes in the geographic distribution of PICUs across the United States from 2001 to 2023. **Design:** Cross-sectional study over three time points using geographic methods to calculate distances to the nearest PICU, change in distances to the nearest PICU over time, and changes in rates of access by census tract. **Setting:** U.S. PICUs. **Participants:** None. **Interventions:** None. **Measurements and main results:** The primary outcome was the distance from a given U.S. census tract center to the nearest PICU. Distances were grouped by U.S. census regions and divisions. Most PICUs were located in urban areas. The median distance from census tract centers to the nearest PICU was 12.5 miles (interquartile range [IQR], 4.5-37.1 miles), 12.8 miles (IQR, 4.9-36.2 miles), and 13.3 miles (IQR, 5.2-36.0 miles) for 2001, 2016, and 2023, respectively. In all years, PICUs were localized to a single city in Arkansas, Nebraska, and Oregon, and there were no PICUs in Wyoming. In 2023, the median distance to a PICU from the nearest census tract was 7.4 miles in the Middle Atlantic division (NJ, NY, and PA) and 30.1 miles in the East South Central division (AL, KY, MS, and TN). The distance to a PICU was shorter for coastal regions compared with large areas of the Mountain and Pacific divisions. **Conclusions:** The geographic distribution of PICUs across the U.S. varied over time, with PICU beds remaining concentrated in urban areas, whereas rural areas were farther from the nearest PICU. This results in inequitable access for critically ill children, particularly in the western U.S. Understanding the variation in geographic access to PICUs is an essential step toward ensuring equitable access to life-saving care for all children. **Keywords:** disaster planning; geospatial; inpatient pediatrics; pediatric intensive care unit; rural healthcare. Copyright © 2026 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Dr. Shih received funding from the University of Nebraska Medical Center; she received support for article research from the University of Nebraska Medical Center; she disclosed work for hire. Dr. Cifra’s institution received funding from Controlled Risk Insurance Company (CRICO); she received funding from De Gruyter Brill. Dr. Randolph received funding from UpToDate, Thermo Fisher, and Inotrem. The remaining authors have disclosed that they do not have any potential conflicts of interest. ## References 1. 1. Killien EY, Keller MR, Watson RS, et al.: Epidemiology of intensive care admissions for children in the US from 2001 to 2019. JAMA Pediatr 2023; 177:506–515 2. 1. LaRovere KL, Murphy SA, Horak R, et al.: Pediatric neurocritical care: Evolution of a new clinical service in PICUs across the United States. Pediatr Crit Care Med 2018; 19:1039–1045 3. 1. Farr BJ, McEvoy LTCS, Ross-Li D, et al.: Geographic distance to extracorporeal life support centers for pediatric patients within the Continental United States. Pediatr Crit Care Med 2021; 22:e594–e598 4. 1. Horak RV, Griffin JF, Brown AM, et al.; Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network: Growth and changing characteristics of Pediatric Intensive Care 2001-2016. Crit Care Med 2019; 47:1135–1142 5. 1. Winthrop ZA, Perez JM, Staffa SJ, et al.: Pediatric respiratory syncytial virus hospitalizations and respiratory support after the COVID-19 pandemic. 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