{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:21:41Z","timestamp":1758846101525,"version":"3.44.0"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background and purpose<\/jats:title>\n<jats:p>Rural-urban disparities in neurological care have been well documented, but limited data exist regarding Guillain-Barr\u00e9 Syndrome (GBS). This study examines differences in patient demographics, hospital characteristics, and outcomes among GBS admissions to rural versus urban hospitals in the United States.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Using the 2021 National Inpatient Sample, we conducted a retrospective cohort study of adult hospitalizations with a principal diagnosis of GBS. Hospitals were classified as rural or urban based on U.S. census designations. Multivariate logistic and linear regression models were used to assess associations between hospital location and outcomes, adjusting for demographic, clinical, and hospital-level factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>An estimated 10,035 weighted Guillain-Barr\u00e9 Syndrome hospitalizations were identified, of which 95.8% occurred in urban hospitals. Rural hospitalizations involved older individuals (mean age 56.8 years; 95% CI: 52.5\u201361.0) compared to urban hospitalizations (51.3 years; 95% CI: 50.3\u201352.2). Adjusted analyses showed no significant differences in in-hospital mortality (adjusted OR 2.00; 95% CI: 0.11\u201335.12) or length of stay (mean difference \u22121.85 days; 95% CI: \u22126.62 to 2.91). However, total hospital charges were significantly higher in urban hospitals, with an average difference of $39,474 (95% CI: $4,296\u2013$74,651). Discharge disposition was comparable, with 40% of rural hospitalizations and 48.1% of urban hospitalizations discharged home, and 38.8% versus 43.3% discharged to skilled nursing facilities (all p\u2009&gt;\u20090.05).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this national analysis of over 10,000 Guillain-Barr\u00e9 Syndrome hospitalizations, rural and urban hospitals achieved comparable outcomes in terms of in-hospital mortality, length of stay, complications, and discharge disposition. Rural hospitalizations tended to involve older individuals from lower-income areas, whereas urban hospitals managed more cases with severe comorbidities and generated substantially higher costs. These findings suggest that rural hospitals are capable of delivering effective acute care for GBS, and highlight the need for future research on long-term functional outcomes across geographic settings.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333403","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T17:29:32Z","timestamp":1758821372000},"page":"e0333403","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing Guillain-Barr\u00e9 syndrome outcomes between rural and urban hospitals in the United States: A retrospective cohort study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4858-1823","authenticated-orcid":true,"given":"Anudeep","family":"Surendranath","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rahul","family":"Damani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0113-4560","authenticated-orcid":true,"given":"Anushareddy","family":"Muddasani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anupam Kumar","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"issue":"24","key":"pone.0333403.ref001","doi-asserted-by":"crossref","first-page":"2294","DOI":"10.1056\/NEJMra1114525","article-title":"Guillain-Barr\u00e9 syndrome","volume":"366","author":"N Yuki","year":"2012","journal-title":"N Engl J Med"},{"issue":"10","key":"pone.0333403.ref002","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/S1474-4422(08)70215-1","article-title":"Clinical features, pathogenesis, and treatment of Guillain-Barr\u00e9 syndrome","volume":"7","author":"PA van Doorn","year":"2008","journal-title":"Lancet Neurol"},{"issue":"8","key":"pone.0333403.ref003","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1038\/nrneurol.2014.121","article-title":"Guillain-Barr\u00e9 syndrome: pathogenesis, diagnosis, treatment and prognosis","volume":"10","author":"B van den Berg","year":"2014","journal-title":"Nat Rev Neurol"},{"issue":"5","key":"pone.0333403.ref004","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1038\/s41582-021-00467-y","article-title":"Guillain-Barr\u00e9 syndrome in low-income and middle-income countries: challenges and prospects","volume":"17","author":"N Papri","year":"2021","journal-title":"Nat Rev Neurol"},{"issue":"10","key":"pone.0333403.ref005","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.1093\/brain\/awy232","article-title":"Regional variation of Guillain-Barr\u00e9 syndrome","volume":"141","author":"AY Doets","year":"2018","journal-title":"Brain"},{"issue":"9","key":"pone.0333403.ref006","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1093\/brain\/awm004","article-title":"Immunotherapy for Guillain-Barr\u00e9 syndrome: a systematic review","volume":"130","author":"RAC Hughes","year":"2007","journal-title":"Brain"},{"issue":"11","key":"pone.0333403.ref007","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1038\/s41582-019-0250-9","article-title":"Diagnosis and management of Guillain-Barr\u00e9 syndrome in ten steps","volume":"15","author":"SE Leonhard","year":"2019","journal-title":"Nat Rev Neurol"},{"issue":"18","key":"pone.0333403.ref008","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1212\/WNL.0b013e3182904fcc","article-title":"Mortality in Guillain-Barre syndrome","volume":"80","author":"B van den Berg","year":"2013","journal-title":"Neurology"},{"issue":"7","key":"pone.0333403.ref009","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1136\/jnnp-2011-301882","article-title":"Outcome and its predictors in Guillain-Barre syndrome","volume":"83","author":"YA Rajabally","year":"2012","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"8","key":"pone.0333403.ref010","doi-asserted-by":"crossref","DOI":"10.1111\/ene.16365","article-title":"Guillain-Barr\u00e9 syndrome: a comprehensive review","volume":"31","author":"R Bellanti","year":"2024","journal-title":"Eur J Neurol"},{"issue":"7","key":"pone.0333403.ref011","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1161\/STROKEAHA.120.029318","article-title":"Urban-Rural Inequities in Acute Stroke Care and In-Hospital Mortality","volume":"51","author":"G Hammond","year":"2020","journal-title":"Stroke"},{"key":"pone.0333403.ref012","unstructured":"Bureau UC. 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