Background: Two systems exist for evaluating the abilities of trauma centers: the American College of Surgeons’ (ACS) verification and the State’s designation. Given criteria variations between the two systems, we studied clinical outcome variations of the same. Methods: The National Trauma Databank was queried from 2002 - 2009, 2013 & 2014 for all patients admitted to a State designated (SI) or ACS verified (AI) trauma facility. Centers that were exclusively state or ACS designated were used for analysis. Patient demographics, facility information and physiological variables were obtained. Outcome variables included length of stay, no of patients with complications and mortality. Multivariate logistic or linear regression analyses were employed for assessing outcome variations. Results: Of the 12,581,375 trauma admissions, 1,504,848 (12%) met the inclusion criteria with 15 AI and 94 SI exclusive facilities identified. Patient demographics were 66% male, 62 - 63% white and 81% blunt injury. Higher length of stay, mortality, and complications were noted in SI vs. AI centers. Conclusions: Our results indicate ACS verified level I trauma centers have better clinical outcomes than State designated level I trauma centers. This study warrants future prospective studies to determine the impact of level of designation on clinical outcomes.