OBJECTIVE: To determine nursing resource utilization (acuity hours and dollars) by trauma patients based on analysis of a nursing acuity system and five trauma scoring systems. METHODS: Retrospective review of 448 trauma patients who required transport by aircraft to a level I trauma center. Values from the institution's automated nursing acuity system were compared with the Glasgow Coma Scale score, trauma score, revised trauma score, CRAMS score and injury severity score to obtain acuity hours and financial cost of care for trauma patients. RESULTS: Consistently, analysis of scores computed by five scoring instruments confirmed that nursing resource utilization is greatest for patients who are severely injured but likely to recover. For example, patients with a trauma score of 1 required 49 (+/- 66) mean acuity hours of care; those with a trauma score of 8 needed 189 (+/- 229) mean acuity hours; and those with a trauma score of 16 used 73 (+/- 120) mean acuity hours. Mean dollar costs were $980 (+/- 1293), $3812 (+/- 4518) and $1492 (+/- 2473), respectively. CONCLUSIONS: Nursing resource utilization can be determined for trauma patients by using an automated nursing acuity system and trauma scoring systems. Data acquired in this way provide a concrete basis for healthcare and reimbursement reform, for administrators who design nursing allocations and for nursing educators who prepare graduates to meet the needs of healthcare consumers.