Abstract Background ACS verification is believed to provide benefits for trauma patients but is associated with direct costs. Study Design One-year retrospective review of the NTDB for 2012. Patients separated into three age groups; Pediatric (PEDS) 0-14, Adult 15-65, and elderly (ELD), >65. We analyzed 2 injury severity cohorts, ISS 9-74 (ALL) and ISS 25-74 (MAJ). Multiple logistic regression to determine significance of ACS verification on mortality and major complications, controlling for age, ISS, shock, GCS, gender, age, co-morbidities and mechanism. Patients excluded with an ISS < 8 or equal to 75, DOA, ED transfers and burns. Results There were 392,997 patients, 262,644 in ACS, 130,353 non-ACS centers. PEDS 3.8%, adults 64.5%, ELD 31.7%. For ALL adults, no differences observed for either primary outcome in ACS vs non-ACS centers (p=.128, .061, for mortality, complications). For ALL PEDS and ELD, complications were more likely in non-ACS centers: p = .003, OR = 2.61 (CI 1.36-5.0) and p < .0001, OR = 3.17 (CI 2.21-4.56). For MAJ trauma death was more likely in adults in ACS vs non-ACS centers p = .013, OR = .82 (CI .71-.96). Complications for MAJ trauma were more likely in all age groups in non ACS centers adult: p = .028, OR = 1.48 (CI 1.04-2.1); ELD: p < .0001, OR = 2.49 (CI 1.7-3.7); PEDS: p < .0001, OR 4.29 (CI 2.13-8.69). Length of stay was increased for all patients with complications (p < .0001) Conclusions Measurable benefits in complications observed in all age groups with MAJ trauma and in PEDS and ELD for ALL injury severity in ACS vs non-ACS trauma centers.