Trauma Center Death Rates Linked to Patient Population

Injured patients of all races do better at hospitals treating mostly white people, study says

By Robert Preidt

Friday, September 13, 2013

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FRIDAY, Sept. 13 (HealthDay News) -- U.S. trauma centers that serve mostly white patients have low death rates for people of all races, while the majority of trauma centers that serve mostly minority populations have higher-than-expected death rates, a new study finds.
Researchers analyzed data from 181 U.S. trauma centers and categorized them as having low, average or high death rates. The numbers in each category were 86 centers, six centers and 89 centers, respectively. Twenty-seven of the trauma centers (15 percent) serve a patient population that is more than 50 percent minority, while most patients at 154 centers are white.
Of the centers with predominately minority patients, 81.5 percent had higher-than-expected death rates. Sixty-four percent of the black patients in the study were treated at centers with high death rates, compared with 41 percent of white patients, the Johns Hopkins researchers found.
The analysis also revealed that 45 percent of patients at centers with high death rates don't have insurance, compared to 21 percent of patients at centers with low death rates, according to the study in the October issue of the journal Annals of Surgery.
Trauma patients were 40 percent less likely to die -- regardless of their race or the extent of their injuries -- if they were treated at hospitals with low death rates (which serve predominantly white patients), the investigators found.
Along with supporting previous research showing that a patient's race and insurance status make a difference in their chances of survival after suffering life-threatening injuries, the study shows that hospitals are also an important factor, according to the researchers.
"It's not just differences in the patients," Dr. Adil Haider, an associate professor of surgery at the Johns Hopkins University School of Medicine, said in a Hopkins news release.
"All patients of all races do better at the trauma centers treating white majority populations, so this research tells us we need to direct attention to hospitals with higher mortality rates to help them improve their outcomes, or we won't ever be able to turn this around," noted Haider, who is also director of the Center for Surgery Trials and Outcomes Research at Johns Hopkins.
He said that hospitals serving mainly white people may have more money because they have a higher percentage of well-insured patients and receive more donations. This means they can afford staff training and other measures to continually improve care.
"We need to find a way to help poorly performing trauma centers improve. In most cases, these centers are doing a very difficult job without enough resources. And if we try, we can certainly help these centers achieve better outcomes. It can't continue to be the case that the color of a patient's skin determines whether he or she survives a serious injury," Haider said.

SOURCE: Johns Hopkins Medicine, news release, Sept. 11, 2013

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