OBJECTIVES Trauma patients often experience significant hemorrhage and, therefore, may require more resources during hospitalization than patients who do not hemorrhage. The cost of blood/blood products is poorly understood in trauma patients and not well documented in the literature. Our objective was to evaluate the outcomes and cost of care for trauma patients based on bleeding status. METHODS Patients with costs and length of stay (LOS) greater than zero, discharged between January 1, 2010 and December 31, 2012, were identified in the Premier Hospital Database based on select ICD9 codes. All costs were based on hospital reported costs. Patients who received blood products prior to the day of surgery were excluded. Multivariate regression models for costs and LOS used log transformation techniques. RESULTS A total of 62,527 patients (8,800 Bleeding; 53,727 Non-Bleeding) were included. Patients who received blood/blood products were significantly different in a number of baseline characteristics including Charlson Comorbidity Index. Unadjusted outcomes demonstrated significant differences in mean total costs ($43,375 Bleeding; $18,411 Non-Bleeding; p<0.001) and LOS (13.62 Bleeding; 7.53 Non-Bleeding; p<0.001) for patients who received blood products compared with those who did not. Multivariate models adjusting for patient characteristics demonstrated that patients who received blood/blood products had 38.9% greater LOS and 34.3% greater ICU LOS. They also were 3.53 times as likely to be admitted to the ICU, 3.75 times as likely to be readmitted for bleeding and 4.09 times as likely to die in hospital (all p<0.001). Furthermore, they had 32.9% greater total cost of care including blood product cost and 31.8% greater total cost of care excluding blood product cost (both p<0.001).  CONCLUSIONS Preventing or rapidly controlling emergent bleeding in trauma patients would likely reduce patient risk and avoid elevated costs of hospitalization.