Trauma causes staggering losses: in 1987, Hermann Hospital lost $8 million to uncompensated trauma care. To demonstrate the survivability of pediatric trauma care delivery we examined reimbursement profiles for adult and pediatric trauma patients. We retrospectively reviewed the records of 3445 patients with serious trauma from October 1987 through March 1992. The group was divided into adult (> or = 17 years) and pediatric patients (< 17 years). We compared reimbursement profiles based on hospital costs generated, reimbursement, financial class, demographics, discharge diagnostic codes, and outcome. Significance was assessed by t test and Chi-square. We found a decreased length of stay (LOS) and a lower association with under-reimbursement or zero reimbursement in pediatric patients. A significantly lower percentage of pediatric patients paid none of their bill (17.1%) compared with the adults (23.2%). Pediatric reimbursement exceeded hospital costs (110.0%) compared with adult reimbursement (90.3%). This suggests that pediatric trauma care can survive in an atmosphere of shrinking resources.