This cross-sectional analysis evaluated changes in the geographic distribution of pediatric intensive care units (PICUs) across the United States at three time points: 2001, 2016, and 2023. The primary objective was to identify and describe temporal shifts in geographic access by measuring distance from each U.S. census tract center to the nearest PICU and by assessing changes in access rates by census tract over time.
The authors applied geospatial methods to calculate the straight-line distance (centroid-to-facility) from every U.S. census tract center to the nearest PICU. Distances were summarized at national and regional levels and stratified by U.S. census regions and divisions. The analysis reported median distances with interquartile ranges (IQR) for each time point and described changes in spatial distribution and localization of PICU services across states and divisions.
Across the three time points studied, PICU locations remained concentrated in urban centers. The national median distance from a census tract center to the nearest PICU rose modestly over time: 12.5 miles (IQR, 4.5–37.1 miles) in 2001; 12.8 miles (IQR, 4.9–36.2 miles) in 2016; and 13.3 miles (IQR, 5.2–36.0 miles) in 2023. These medians indicate that while many census tracts were relatively close to a PICU, a substantial portion of tracts—reflected in the upper IQR values—were located far from the nearest facility.
Geographic access varied markedly by census division. In 2023, the Middle Atlantic division (New Jersey, New York, and Pennsylvania) had a median distance of 7.4 miles to the nearest PICU, representing one of the shortest regional median distances reported. By contrast, the East South Central division (Alabama, Kentucky, Mississippi, and Tennessee) had a median distance of 30.1 miles in 2023, among the longest reported. The authors note that coastal divisions tended to have shorter distances to PICUs, whereas large areas within the Mountain and Pacific divisions had greater median distances and consequently reduced geographic access.
The analysis found persistent urban concentration of PICU beds in all examined years. At the state level, several notable patterns were reported: Arkansas, Nebraska, and Oregon each had PICUs localized to a single city, highlighting highly focalized access within those states. Wyoming had no PICUs across the studied period. These patterns illustrate how state-level PICU distribution can create areas of concentrated access juxtaposed with areas effectively lacking nearby pediatric critical care.
The authors conclude that the observed geographic distribution produces inequitable access to pediatric critical care across the U.S. Rural and many western areas remain farther from PICUs, which has implications for time-sensitive, life-saving care for critically ill children. The study frames mapping and quantification of geographic access as an essential foundational step toward targeted planning, disaster preparedness, and policy measures intended to improve equitable access to pediatric intensive care services.
The abstract reports study design and core results but does not provide detailed methodological limitations or specific proposed interventions; such details were not reported in the abstracted material provided. The study emphasizes the need to understand variation in geographic access as a prerequisite for efforts to ensure equitable access to pediatric critical care, particularly in regions identified as having the greatest distances to the nearest PICU.
From 2001 to 2023, PICU beds in the U.S. remained concentrated in urban areas, with modest increases in median distance from census tract centers to the nearest PICU. Significant regional disparities persist, with coastal divisions showing shorter distances and parts of the Mountain, Pacific, and some southern divisions showing substantially longer distances. State-level localization (single-city PICUs) and complete absence in at least one state underscore the potential for inequitable access to pediatric critical care. The authors highlight that measuring and mapping these disparities is a necessary step toward improving equitable access to life-saving pediatric services.