A retrospective analysis of medical and financial records of trauma patients admitted over a 4-year period was undertaken to determine the impact of level 1 pediatric trauma center designation on demographics and financial reimbursement. Three hundred fifty-four patients were admitted from November 1, 1985, to October 31, 1986 (Prelevel 1 designation [PREL1]). Five hundred seven patients were admitted from November 1, 1986, to October 31, 1987 (Postlevel 1 designation [PostL1]) (P less than .005). Mechanisms of injury were similar in both groups, with falls being most prevelant (PreL1, 50.8%; PostL1, 43.4%). The magnitude of injuries in the PostL1 period, as expressed by Pediatric Trauma Scores and Injury Severity Scores, did not change significantly. The types of injuries, as indicated by organ systems involved, did not change. The exception was thoracic injuries, which increased from 1.7% to 4.5% (P = .037). Total hospital charges per patient increased ($5,820 PreL1; $7,691 PostL1) (P = .034). Collection rates did not change (77.6% PreL1; 76.4% PostL1). The institution incurred a financial loss per patient of $1,149 PreL1 and $1,795 PostL1 (P = .055). Years 2 and 3 PostL1 designation were analyzed to identify trends (year 2 PostL1: November 1, 1987 to October 31, 1988 [488 patients]; year 3 PostL1: November 1, 1988 to October 31, 1989 [459 patients]). The distribution of Pediatric Trauma Scores and Injury Severity Scores did not change. Total hospital charges per patient remained fairly constant ($8,082 year 2 PostL1; $7,276 year 3 PostL1). Unreimbursed costs increased significantly compared with losses during the PostL1 period ($4,262 year 2 PostL1, P less than .005; $2,799 year 3 PostL1, P = .04).(ABSTRACT TRUNCATED AT 250 WORDS)