Trauma outcomes differ significantly based on treatment at level I versus level II centers, impacting patient selection for serious injuries.

• Analyzing 363,470 trauma patients, level I centers had a higher unadjusted mortality (8.2%) compared to level II (6.9%), but adjusted outcomes showed no overall difference.
• Level I centers had lower adjusted mortality for shock patients and those with blunt multisystem trauma.
• Surgeons should consider rapid transfer protocols for physiologically unstable blunt trauma patients to optimize survival chances.