OBJECTIVES: This study analyzes the costs of hospital care to children with TBI before and after a pediatric neurocritical care center (PNCC) implementation. A previous study with this sample showed improved clinical outcomes. METHODS: This retrospective cohort study includes 63 patients in the pre-PNCC group, and 59 post-PNCC patients.  We merged demographic and clinical data with cost data from the hospital finance office for the same patient hospitalization.  Outcome variables included total cost percentage ((direct + overhead)/median total cost pre-PNCC*100%), and overall length of stay (LOS) and PICU LOS.  Mann-Whitney U’s, chi-squares, and multiple linear regression were utilized. RESULTS: Gender, race, injury mechanism, age at admission, Glasgow Coma Score, and PRISM III score were similar in the pre and post-PNCC groups (p>0.05 for all).  While PICU length of stay (LOS) increased post-PNCC (median (IQR) pre: 11 (5-15) v. post: 14 (7-22), p = 0.02), the overall hospital LOS did not change (pre: 32 (14-55) v. post 37 (17-58), p = 0.42.   Total cost percentage increased from a median(IQR) of 100% (61-181%) to 143% (95-218%), p = 0.04.  After adjusting for covariates, total costs percentage was still significant post-PNCC compared to pre-PNCC (b(se) = 16.2(5.4), p = 0.003).  LOS and PICU LOS were also positively related to total costs (b(se) = 2.6(0.1) and 2.6 (0.4) respectively, p <0.0001 for both).   CONCLUSIONS: After adjusting for PICU LOS, PNCC implementation remained associated with an increase in total cost.  One would need to look outside of the initial hospitalization to determine if PNCC is cost effective given the improved clinical outcomes.      Pineda et al. Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study. The Lancet Neurology , Volume 12 , Issue 1 , p 45 – 52.  January 2013.