The Role of Geographic Isolation and Indigeneity on Canadian Neurosurgical Outcomes: A Systematic Review
Bibliographic record
Abstract
Introduction Timely neurosurgical care is critical, yet Canada’s specialized services are concentrated in urban centres and rarely designed with Indigenous communities. The magnitude of geographic and colonial inequities in neurosurgical care remain unclear. Therefore, the objective is to synthesise quantitative evidence on how rurality and Indigeneity affect neurosurgical mortality, access and functional recovery in Canada Methods Following PRISMA guidelines, a systematic literature search of MEDLINE, EMBASE, Cochrane Library, PsycINFO, Web of Sciences and grey‑literature sources was conducted (Jan 2000 - Nov 2024). 1697 records were identified. Following, two reviewers independently screened title and abstracts followed by full-texts and risk of bias was appraised with MINORS. Results Eleven studies (n = 13 337 patients + 310 hospitals) met inclusion criteria: six spinal‑cord injury, two traumatic brain injury, one stroke, one paediatric neuro‑oncology and one hypoxic‑ischaemic brain injury. A rural survival disparity emerged only for acute stroke (30‑day mortality 18.3–21.0 % rural vs 14.1–16.8 % urban). Transport distance did not influence TBI or SCI mortality (adjusted OR per hour 0.98, 95 % CI 0.95-1.01). Median injury‑to‑centre time was ≈3 h, yet 46 % of SCI patients waited ≥24 h for decompression; intermediate transfers doubled this risk (OR 2.48). Rural survivors achieved comparable Functional Independence Measure scores but reported more environmental barriers; Indigenous survivors experienced 70‑day longer hospital stays and six‑fold higher readmissions and complications in comparison to non-Indigenous patients?. Conclusion Outside hyper‑acute stroke, Canadian datasets reveal no rural or Indigenous mortality gap, but substantial in-hospital delays and post-discharge burdens. Policies should prioritise rural CT and telestroke expansion, “direct‑to‑OR” trauma pathways, and culturally safe discharge programs.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".