Evidence-based management guidelines have been shown to improve patient outcomes, yet their utilization by trauma centers remains unknown. This study measured adoption of practice management guidelines or protocols by trauma centers. A survey of 228 trauma centers was conducted over 1 year; 55 completed the survey. Centers were classified into three groups: noncompliant, partially compliant, and compliant with adoption of management protocols. Characteristics of compliant centers were compared with those of the other two groups. Most centers were Level I (58%) not-for-profit (67%) teaching hospitals (84%) with a surgical residency (74%). One-third of centers had an accredited fellowship in surgical critical care (37%). Only one center was compliant with all 32 management protocols. Half of the centers were compliant with 14 of 32 protocols studied (range, 4 to 32). Of the 21 trauma center characteristics studied, only two were independently associated with compliant centers: use of physician extenders and daily attending rounds (both P < .0001). Adoption of management guidelines by trauma centers is inconsistent, with wide variations in practices across centers.T he trauma center designation process is based on the availability of optimal resources for care of the injured (1). However, availability of optimal resources does not necessarily translate into delivery of optimal care (2). Studies have shown wide variations in risk-adjusted outcomes across designated trauma centers despite availability of optimal resources, suggesting that diff erences in outcomes are likely related to variations in clinical practices (3). Evidence-based practice management guidelines have improved patient outcomes in several diseases (4). In trauma, many professional societies have developed evidence-based management protocols (5-10). However, presently, use of these management protocols by trauma centers remains unknown. We have previously shown that compliance with guidelines remains inadequate, with less than two-thirds of the indicated care provided (3). Th erefore, worse-than-expected outcomes at certain trauma centers may be due to clinical practice patterns. A possible remedy is to emphasize adoption of management protocols and mechanisms to ensure compliance with them. Th e purpose of this study was to measure adoption of practice management guidelines or protocols recommended by professional societies in a national sample of designated trauma centers. A secondary goal was to