Objectives: The primary purpose of this study was to evaluate whether severely injured geriatric patients were as likely to be treated at designated trauma centers (TCs) within the statewide trauma system. The secondary objective was to compare the demographic and injury characteristics of severely injured older and young patients who received care in TCs with the characteristics of those patients cared for in non-TCs. Methods: The authors reviewed files for all acute injury discharges in Pennsylvania for 1997. Injury diagnoses were mapped to Abbreviated Injury Scale (AIS) scores using ICDMAP software; the Injury Severity Score (ISS) was computed. The frequency of hospital discharges for injury from TC and non-TC hospitals in both the older (E) (≥65 years) and younger (Y) (<65 years) groups were computed, and compared using chi-square testing for significance. Logistic regression was performed to assess the influence of various factors. Severity of injury was controlled for with both ISS and Maximum AIS (MAIS). Results: 107,358 patients were admitted to hospitals in the state because of injury; 8,980 had an ISS > 15; 5,855 were Y and 3,125 were E. Forty-seven percent of the Y patients received TC care compared with only 36.6% of the E patients (p < 0.001). Logistic regression analysis showed that age was a strongly negative predictor for TC care when injury severity was controlled. Conclusions: Seriously injured older patients were less likely to receive care in a trauma center than younger patients.