The effects of alcohol use, age, and injury severity on outcome in 1,000 vehicular crash victims admitted to a Level I urban trauma center were studied. Among the entire sample of 1000 patients, blood alcohol level (BAL), was not associated with overall mortality (measured as survival to discharge). There was no association between positive or negative BAL and ISS score among all cases. Among those patients involved in automobile crashes who were clearly at risk of dying (defined as ISS>16) the death rate was significantly lower for those who had positive BALs compared those with negative BALs (MR 11.3% vs 22.3% p<.03). This difference appears to be explained however by the finding that those who had not been drinking presented with significantly higher ISS scores and were significantly older compared to the group of patients admitted with positive BALs. Implications of these findings relative to previous and future clinical studies of trauma center patients are discussed.