Racial Differences and Injury Pattern Variation: Impact of COVID-19 on a Bronx Trauma Center.

BACKGROUND: New York City (NYC) became the epicenter of the COVID-19 pandemic in 2020. The Bronx, with the highest rates of poverty and violent crime of all NYC boroughs and a large Black and Hispanic population, was at increased risk of COVID-19 and its sequelae. We aimed to identify temporal associations among COVID-19 and trauma admission volume, demographics, and mechanism of injury (MOI). METHODS: A retrospective review of prospectively collected data was conducted from a Level II trauma center in the Bronx. January 1st-September 30th for both 2019 (Pre-COVID) and 2020 (COVID) were compared. Pre-COVID and COVID cohorts were subdivided into EARLY (March-May) and LATE (June-September) subgroups. Demographics and trauma outcomes were compared. RESULTS: Trauma admissions were similar between Pre-COVID and COVID. During COVID, there was an increased percentage of Black patients (Black Hispanic 20.1% vs 15.2% and Black Non-Hispanic 39.4% vs 34.1%, P < .05), younger patients (26-35 years old: 22.6% vs 17.6%, P < .05), and out-of-pocket payors (6.0% vs 1.6%, P < .05). Trauma severity outcomes were mixed-some measures supported increased severity; others showed no difference or decreased severity. During COVID, there was a rise in total penetrating injuries (27.4% vs 20.8%, P < .05), MVC (13.2% vs 7.1, P < .05), and firearm injuries (11.6% vs 6.0%, P < .05). Additionally, during LATE COVID, there was a resurgence of total penetrating, total blunt, MVC, falls, cyclists/pedestrians struck, and firearm injuries. DISCUSSION: Our results emphasize MOI variations and racial differences of trauma admissions to a Level II trauma center in the Bronx during COVID-19. These findings may help trauma centers plan during pandemics and encourage outreach between trauma centers and community level organizations following future healthcare disasters.

Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes.

Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (-67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.

Mechanism of injury predicts case fatality and functional outcomes in pediatric trauma patients: the case for its use in trauma outcomes studies.

BACKGROUND/PURPOSE: The mechanism of injury (MOI) may serve as a useful adjunct to injury scoring systems in pediatric trauma outcomes research. The objective is to determine the independent effect of MOI on case fatality and functional outcomes in pediatric trauma patients. METHODS: Retrospective review of pediatric patients ages 2 to 18 years in the National Trauma Data Bank from 2002 through 2006 was done. Mechanism of injury was classified by the International Classification of Diseases, Ninth Revision, E codes. The main outcome measures were mortality, discharge disposition (home vs rehabilitation setting), and functional impairment at hospital discharge. Multiple logistic regression was used to adjust for injury severity (using the Injury Severity Score and the presence of shock upon admission in the emergency department), age, sex, and severe head or extremity injury. RESULTS: Thirty-five thousand ninety-seven pediatric patients in the National Trauma Data Bank met inclusion criteria. Each MOI had differences in the adjusted odds of death or functional disabilities as compared with the reference group (fall). The MOI with the greatest risk of death was gunshot wounds (odds ratio [OR], 3.52; 95% confidence interval [CI], 2.23-5.54 95). Pediatric pedestrians struck by a motor vehicle have the highest risk of locomotion (OR, 3.30; 95% CI, 2.89-3.77) and expression (OR, 1.65; 95% CI, 1.22-2.23) disabilities. CONCLUSION: Mechanism of injury is a significant predictor of clinical and functional outcomes at discharge for equivalently injured patients. These findings have implications for injury prevention, staging, and prognosis of traumatic injury and posttreatment planning.

Validation of a relative head injury severity scale for pediatric trauma.

BACKGROUND: Brain injury is the most important independent predictor of mortality and morbidity in pediatric trauma. The Glasgow Coma Score (GCS) is the commonly used clinical instrument to assess brain injury. However, the GCS or one of its components is often not applicable in children under a certain age or cannot be computed reliably because of the patient's condition or the circumstances surrounding resuscitation efforts. This limits its usefulness in statistical models of trauma outcomes, which rely on complete data collection and entry into trauma registries. This study provides evidence validating use of a relative head injury severity scale (RHISS) derived from available International Classification of Diseases, 9th Revision (ICD-9) diagnosis codes to stratify degree of head injury. METHODS: The patient population was derived from the National Pediatric Trauma Registry (NPTR;1994-2001). Survival Risk Ratios (SRRs) were computed for each head injury ICD-9 code. ICD-9 diagnosis codes related to head injury were then assigned to a RHISS category based on duration of loss of consciousness, location of skull fracture, or both: 0 = none; 1 = mild; 2 = moderate, or 3 = severe head injury. Analysis of variance compared mean SRRs across RHISS categories. Each patient was then assigned to a RHISS category based on their single worst ICD-9 head injury code. Logistic regression analysis was used to predict mortality based on New Injury Severity Score (NISS), whether the patient had been intubated, RHISS, and the Abbreviated Injury Score (AIS) for head and neck injuries. RESULTS: GCS score was missing for 96% of nonsurvivors in the NPTR. Mean SRRs differed significantly (p < 0.001) among ICD-9 codes assigned to each RHISS category, as follows (Mean +/- SD): RHISS (0) = 0.93 +/- 0.16; RHISS (1) = 0.89 +/- 0.22; RHISS (2) = 0.85 +/- 0.26; RHISS (3) = 0.55 +/- 0.35. Logistic regression identified RHISS as an independent significant predictor (p < 0.01) of mortality. CONCLUSION: RHISS is a valid index of degree of head injury in the pediatric trauma population. Unlike GCS, RHISS is more likely to be available in trauma registries, and can be computed from administrative data. RHISS provides a feasible and valid method for quantifying the degree of brain injury in statistical models of pediatric trauma outcome.

Black children experience worse clinical and functional outcomes after traumatic brain injury: an analysis of the National Pediatric Trauma Registry.

BACKGROUND: Recent studies suggest racial disparities in the treatment and outcomes of children with traumatic brain injury (TBI). This study aims to identify race-based clinical and functional outcome differences among pediatric TBI patients in a national database. METHODS: A total of 41,122 patients (ages 2-16 years) who were included in the National Pediatric Trauma Registry (from 1996-2001) were studied. TBI was categorized by Relative Head Injury Severity Score (RHISS) and patients with moderate to severe TBI were included. Individual race groups were compared with white as the majority group. Differences between races in functional outcomes at discharge in three domains-speech, locomotion, and feeding-were determined using multiple logistic regression. Cases were adjusted for age, sex, severity of head injury (using RHISS), severity of injury (using New Injury Severity Score and Pediatric Trauma Score), premorbidities, mechanism, and injury intent. RESULTS: A total of 7,778 children had moderate or severe TBI with or without associated injuries. All races had similar demographics. Hispanics (n=1,041) had outcomes comparable to whites (n=4,762). Black children (n=1,238) had significantly increased premorbidities, penetrating trauma, and violent intent. They also had higher unadjusted mortality and longer mean intensive care unit and floor stays. After adjustment, there was no difference in the odds of death between black and white children. However, black patients were more likely to be discharged to an inpatient rehabilitation facility and had increased odds of possessing a functional deficit at discharge for all three domains studied. CONCLUSION: Black children with traumatic brain injury have worse clinical and functional outcomes at discharge when compared with equivalently injured white children.

Intubation of pediatric trauma patients in the field: predictor of negative outcome despite risk stratification.

BACKGROUND: Recently, evidence has shown that intubation in the field may not improve or may even adversely affect outcomes. Our objective was to analyze outcomes in pediatric intubated trauma patients using a large national pediatric trauma registry. METHODS: The patient population was derived from the last phase of the National Pediatric Trauma Registry, comprising admissions from 1994 through 2002. Intubated patients were identified, as was their place of intubation: in the field, at a hospital that was not a trauma center, and at a trauma center. Risk stratification was performed for mortality using logistic regression models and variables available at presentation to the emergency room. Odds ratio and variable significance were calculated from the logistic regression model. The percentage of patients discharged to home and an abnormal Functional Independence Measure at hospital discharge examined functional outcome of survivors. RESULTS: There were a total of 50,199 patients, 5460 (11.6%) of whom were intubated (1,930 in the field, 1,654 in the hospital, and 1,876 in a trauma center). Unadjusted mortality rates for intubated patients were as follows: field, 38.5%; hospital, 16.7%; and trauma center, 13.2% (all different, p < 0.05). The developed logistic regression model had an area under the receiver operating characteristic curve of 0.98. Compared with nonintubated patients, the odds ratio for field intubation, for non-trauma center, and for trauma center intubation was 14.4, 5.8, and 4.8, respectively (significantly different field vs. either hospital). The actual (observed) death rate was significantly higher than predicted in those intubated in the field. Stratification of injury by New Injury Severity Score or degree of head injury showed that this difference extended from mild to severe (e.g., odds ratio for New Injury Severity Score < 15 field vs. trauma center intubation, 12.3; odds ratio for none or moderate head injury, 5.1). Similar results were obtained for functional outcome in the survivors. CONCLUSION: Field intubation is an independent strong negative predictor of survival or good functional outcome despite adjustment for severity of injury. Although not causal, the magnitude of these differences should lead to future controlled studies of pediatric trauma field intubations.

A need for reevaluation of sports participation recommendations for children with a solitary kidney.

PURPOSE: We sought to evaluate the incidence and outcome of blunt renal injury in children by mechanism of injury. These data could then be used to provide the basis for more rational recommendations to parents and physicians regarding participation in sporting activities. MATERIALS AND METHODS: We analyzed data on 49,651 pediatric trauma cases collected by 92 trauma centers as part of the National Pediatric Trauma Registry from 1995 to 2001. Cases involving renal injury were isolated and the data were stratified according to age, sex and injury, as well as procedures required for treatment and outcomes. RESULTS: Of 49,651 pediatric trauma patients 813 incurred renal injury. There were 516 males and 291 females, and sex was not documented in 6 children. Average age was 10.6 years. There were no reports of a solitary kidney. In the sports group there were 4 nephrectomies, which were associated with sledding (2), skiing (1) and rollerblading (1), and 2 deaths related to skiing (1) and jet skiing (1). All 3 nephrectomies in the nonsports/other group were associated with equestrian activities, and 1 death occurred in this population. The nonsports/other group includes minor sports that are outlined by the American Academy of Pediatrics Committee on Sports Medicine and Fitness. CONCLUSIONS: The majority of renal injuries in children associated with kidney loss (21 of 28) occurred as a result of motor vehicle accidents, pedestrians being struck by a vehicle or other object, and falls. There were no kidneys lost in any contact sport. Sledding, skiing and rollerblading resulted in kidney loss. Current recommendations of the American Academy of Pediatrics Committee on Sports Medicine and Fitness prohibiting children with a solitary kidney from participating in contact sports appear to be overly protective and need to be reevaluated. In some instances activities listed as limited contact sports resulted in renal loss, showing that the risk associated with these activities has been underestimated.

Hemodynamic and pulmonary changes after drainage of significant pleural effusions in critically ill, mechanically ventilated surgical patients.

PURPOSE: Our purpose was to study the effects of drainage of significant pleural effusions in mechanically ventilated patients in a surgical intensive care unit. METHODS: Twenty-two ventilated patients in the surgical intensive care unit of a tertiary care center over a 12-month period who developed a pleural effusion large enough to require drainage were studied prospectively. All patients underwent serial portable chest radiography in the upright or semiupright position; the radiographs were reviewed by a radiology attending. Pleural effusions were classified as small, moderate, or large. Moderate or larger effusions were drained using an 8- to 12-Fr pigtail catheter inserted at the bedside under ultrasound guidance. Hemodynamic and pulmonary parameters were collected before and after the fluid was drained. Parameters studied included those outlined in the physiologic profile and included measured and calculated physiologic variables, arterial blood gas measurements, and Svo2 measurements. Ventilator settings before and after were also recorded. RESULTS: Average initial pleural effusion drainage was 1,262 +/- 762 mL (range, 300-2,980 mL). Nine of the 22 patients had effusions drained from both the right and left chest. Blood pressure, systemic vascular resistance, Po2, Pco2, Svo2, Fio2, peak airway pressure, and spontaneous volume did not change significantly. Pulmonary capillary wedge pressure decreased (17.4 +/- 6.0 before, 13.6 +/- 4.4 after; p < 0.01), central venous pressure decreased (14.2 +/- 5.2 before, 11.5 +/- 4.4 after; p < 0.02), and pulmonary arteriovenous shunt decreased (26.7 +/- 15.1 before, 21.0 +/- 7.8 after; p < 0.04). Oxygen delivery increased (579.7 +/- 214.7 before, 662.8 +/- 263.3 after; p < 0.01) and oxygen consumption increased (146.3 +/- 61.6 before, 175.2 +/- 73.8 after; p < 0.01). Respiratory rate also decreased (19.4 +/- 6.5 before, 15.5 +/- 6.3 after; p < 0.05). There were no complications from the placement of the pigtail catheters. CONCLUSION: Drainage of pleural effusions results in increased oxygen delivery and oxygen consumption coinciding with a decrease in pulmonary capillary wedge pressure. The pulmonary arteriovenous shunt decreased, implying an increase in functional residual capacity and improved oxygenation. Further study is needed to determine whether these changes lead to an improved patient outcome (i.e., reduction in length of stay, ventilator days, or mortality).

Determination of national pediatric injury prevention priorities using the Injury Prevention Priority Score.

PURPOSE: Previous studies have found that the Injury Prevention Priority Score (IPPS) provides a reliable and valid method to gauge the relative importance of different injury causal mechanisms at individual trauma centers. This study examines its applicability to prioritizing injury mechanisms on a national level and within defined pediatric age groups. METHODS: A total of 47,158 patients (age <17) in the National Pediatric Trauma Registry were grouped into common injury mechanisms based on ICD-9 E-Codes. Patients also were stratified by age group. IPPS was calculated for each mechanism and within each age group. RESULTS: Falls of all types account for the greatest number of injuries (n = 15,042; 32%), whereas child abuse results in the most severe injuries (mean Injury Severity Score, 13.3) However, the most significant mechanisms of injury, according to IPPS, were motor vehicle crashes followed by pedestrian struck by motor vehicles. Certain age groups had specific injury problems including child abuse in infants and assault and gun injuries in adolescents. CONCLUSIONS: IPPS provides an objective, quantitative method for determining injury prevention priorities based on both frequency and severity at the national level. It also is sensitive to age-related changes in different mechanisms of injury.

Injury prevention priority score: a new method for trauma centers to prioritize injury prevention initiatives.

BACKGROUND: Trauma centers are expected to develop injury prevention programs that address needs of the local population. A relatively simple, objective, and quantitative method is needed for prioritizing local injury prevention initiatives based on both injury frequency and severity. STUDY DESIGN: Pediatric trauma patients (16 years or younger; n= 7,958) admitted to two Level I regional trauma centers (Johns Hopkins Children Center and Westchester Medical Center) from 1993 to 1999 were grouped by injury causal mechanism according to ICD-9 external cause codes. An Injury Prevention Priority Score (IPPS), balancing the influences of severity (based on the Injury Severity Score) and frequency, was calculated for each mechanism and mechanisms were ranked accordingly. RESULTS: IPPS-based rank lists differed across centers. The highest ranked mechanism of injury among children presenting to Johns Hopkins Children Center was "pedestrian struck by motor vehicle," and at Westchester Medical Center it was "motor vehicle crash." Different age groups also had specific injury prevention priorities, eg, "child abuse" was ranked second highest among infants at both centers. IPPS was found to be stable (r = 0.82 to 0.93, p < 0.05) across alternate measures of injury severity. CONCLUSIONS: IPPS is a relatively simple and objective tool that uses data available in trauma center registries to rank injury causes according to both frequency and severity. Differences between two centers and across age groups suggest IPPS may be useful in tailoring injury prevention programs to local population needs.

Prediction of mortality in pediatric trauma patients: new injury severity score outperforms injury severity score in the severely injured.

BACKGROUND: The Injury Severity Score (ISS) is a widely accepted method of measuring severity of traumatic injury. A modification has been proposed--the New Injury Severity Score (NISS). This has been shown to predict mortality better in adult trauma patients, but it had no predictive benefit in pediatric patients. The aim of this study was to determine whether the NISS outperforms the ISS in a large pediatric trauma population. METHODS: Admissions in the National Pediatric Trauma Registry between April 1996 and September 1999 were included. The ISS and NISS were calculated for each patient. The study endpoints were mortality at hospital discharge, functional outcome in three domains (expression, locomotion, and feeding), and discharge disposition for the survivors. Predictive ability of each score was assessed by area under the receiver operating characteristic curve. RESULTS: The NISS and ISS performed equally well at predicting mortality in patients with lower injury severity (ISS < 25), but the NISS was significantly better at predicting mortality in the more severely injured patients. Both scores performed equally well at predicting expression and feeding ability. The NISS was superior to the ISS in predicting locomotion ability at discharge. Thirty-seven percent of patients had an NISS that was higher than their ISS. These patients had a significantly higher mortality and suffered worse functional outcomes. CONCLUSION: The NISS performs as well as the ISS in pediatric patients with lower injury severity and outperforms the ISS in those with higher injury severity.

Mortality risk after head injury increases at 30 years.

BACKGROUND: Age has long been recognized as a critical factor in predicting outcomes after head injury, with individuals older than 60 years predicted to have a worse outcome than those younger than 60. The object of this study was to determine the effect of age by decade of life beginning at birth in patients with head injuries of all levels of severity. STUDY DESIGN: The New York State Trauma Registry was searched for head injuries from January 1, 1994 to December 31, 1995; the 13,908 cases found were placed into age groups by decade. Data were sought for each patient on demographics, Glasgow Coma Score, ICD-9 injury code, New Injury Severity Score (NISS), and mechanism of injury. These data were analyzed with chi-square and one-way ANOVA tests, with significance set at p < 0.05. RESULTS: The risk of dying was significantly increased in patients beginning at 30 years of age compared with those in the younger age groups, with the greatest increases occurring after age 60 (p < 0.001). For the population with available Glasgow Coma Score data (n = 12,844), the mortality rate for patients ages 0 to 30 was 10.9%, and for patients ages 31 to 50 was 12.4%. The mean Glasgow Coma Score for nonsurvivors ages 0 to 20 (3.9) and for nonsurvivors ages 31 to 50 (5.1) were significantly different, with a risk ratio of 1.3 (p < 0.001). CONCLUSIONS: The risk of dying for patients suffering head injuries increases as early as 30 years of age, making it necessary for health-care providers to consider increased monitoring and treatment for patients in this younger age group.

Assessing educational validity of the Morbidity and Mortality conference: a pilot study.

PURPOSE: To assess inter-rater agreement in perceptions of cases presented during Morbidity & Mortality conference (M&M) and changes associated with initiation of a modified M&M. METHODS: Faculty, residents, fellows, and students at weekly M&M between June 2001 and March 2002 voluntarily completed an anonymous questionnaire after each M&M case presentation, which asked: if the complication was avoidable (yes/no/not sure), if consensus was reached among participants (yes/no/not sure), the primary cause of the complication (diagnostic error, technical error, judgment error, nature of disease, other), when the primary cause occurred (preoperatively, intraoperatively, postoperatively), and which, if any, of 16 listed actions could prevent similar future problems. On September 24, 2001, the conference was lengthened and modified. Data collected before (n = 30 cases) and after M&M modification (n = 46 cases) were compared. RESULTS: A total of 76 cases were evaluated for a total of 860 completed forms. In 57 cases (75%), majority opinion (ie, > or =50% of participants) indicated that the complication resulted from either nature of disease (n = 32, 41%), or error in diagnosis (n = 5, 7%), technique (n = 8, 11%) or judgment (n = 12, 17%). There was no clear majority for the remainder of the cases. Relative to cases presented prior to M&M modification, for those presented post-modification, the majority perceived that consensus was reached more often (96% of cases vs. 70% of cases, p<.01), and that complications were more often avoidable (54% of cases vs. 23% of cases, p <.05), more likely caused during the preoperative period (26% of cases vs. 7% of cases, p <.01) and less likely caused during the postoperative period (28% of cases vs. 67% of cases, p <.01). CONCLUSIONS: The variability in questionnaire responses suggests that an evaluation instrument such as that reported here can be useful in assessing educational needs, quantifying the efficacy of case presentations, and assessing the effects of modifications to conference content and structure. Modifying M&M in accordance with published recommendations appears to improve case analysis and consensus among participants.

Traumatic brain injury in the elderly: increased mortality and worse functional outcome at discharge despite lower injury severity.

OBJECTIVE: The purpose of this study was to compare data obtained from a statewide data set for elderly patients (age > 64 years) that presented with traumatic brain injury with data from nonelderly patients (age > 15 and < 65 years) with similar injuries. METHODS: The New York State Trauma Registry from January 1994 through December 1995, from trauma centers and community hospitals excluding New York City (45,982 patients), was examined. Head-injured patients were identified by International Classification of Diseases, Ninth Revision diagnosis codes. A relative head injury severity scale (RHISS) was constructed on the basis of groups of these codes (range, 0 = none to 3 = severe). Comparisons were made with nonelderly patients for mortality, Glasgow Coma Scale (GCS) score at admission and discharge, Injury Severity Score, New Injury Severity Score, and RHISS. Outcome was assessed by a Functional Independence Measure score in three major domains: expression, locomotion, and feeding. Data were analyzed by the chi2 test and Mann-Whitney U test, with p < 0.05 considered significant. RESULTS: There were 11,772 patients with International Classification of Diseases, Ninth Revision diagnosis of head injury, of which 3,244 (27%) were elderly. There were more male subjects in the nonelderly population (78% male subjects) compared with the elderly population (50% men). Mortality was 24.0% in the elderly population compared with 12.8% in the nonelderly population (risk ratio, 2.2; 95% confidence interval, 1.99-2.43). The elderly nonsurvivors were statistically older, and mortality rate increased with age. Stratified by GCS score, there was a higher percentage of nonsurvivors in the elderly population, even in the group with only moderately depressed GCS score (GCS score of 13-15; risk ratio, 7.8; 95% confidence interval, 6.1-9.9 for elderly vs. nonelderly). Functional outcome in all three domains was significantly worse in the elderly survivors compared with the nonelderly survivors. CONCLUSION: Elderly traumatic brain injury patients have a worse mortality and functional outcome than nonelderly patients who present with head injury even though their head injury and overall injuries are seemingly less severe.

Development of a model for prediction of survival in pediatric trauma patients: comparison of artificial neural networks and logistic regression.

BACKGROUND/PURPOSE: There is a paucity of outcome prediction models for injured children. Using the National Pediatric Trauma Registry (NPTR), the authors developed an artificial neural network (ANN) to predict pediatric trauma death and compared it with logistic regression (LR). METHODS: Patients in the NPTR from 1996 through 1999 were included. Models were generated using LR and ANN. A data search engine was used to generate the ANN with the best fit for the data. Input variables included anatomic and physiologic characteristics. There was a single output variable: probability of death. Assessment of the models was for both discrimination (ROC area under the curve) and calibration (Lemeshow-Hosmer C-Statistic). RESULTS: There were 35,385 patients. The average age was 8.1 +/- 5.1 years, and there were 1,047 deaths (3.0%). Both modeling systems gave excellent discrimination (ROC A(z): LR = 0.964, ANN = 0.961). However, LR had only fair calibration, whereas the ANN model had excellent calibration (L/H C stat: LR = 36, ANN = 10.5). CONCLUSIONS: The authors were able to develop an ANN model for the prediction of pediatric trauma death, which yielded excellent discrimination and calibration exceeding that of logistic regression. This model can be used by trauma centers to benchmark their performance in treating the pediatric trauma population.

The effects of motorcycle helmet use between hospitals in states with and without a mandatory helmet law.

BACKGROUND: Motorcycle injuries and mortality are different depending on the use of a helmet. Helmet use varies greatly depending on state laws. METHODS: Retrospective study using trauma registry data from two Level 1 Trauma Centers in states with (NY) and without (CT) a mandatory helmet law, from 1996 through 1998. RESULTS: Motorcycle accident victims in both states were similar for sex, age, RTS, TRISS probability of survival, GCS on arrival and ISS. Helmet use was higher in New York than in Connecticut (91% vs 18%, P < .01). Mortality was higher in Connecticut than in New York (15% vs 6%, P < .05). CONCLUSION: The demographics and injury severity of motorcycle accident victims presenting to Level 1 Trama Centers were very similar in the two adjoining states. The most significant difference between the states is that of helmet use. This is closely related to the decreased mortality rate and the higher GCS at discharge seen in the state with the mandatory helmet law.