We reviewed the hospital records and autopsy data of all deaths occurring at a Level I Trauma Center during a 1-year interval to determine the epidemiology of traumatic death in a regionalized system of care: 1,581 patients were admitted and 106 died (6.6%). Nonsurvivors (NS) differed significantly from survivors (S) in age, Trauma Score, Injury Severity Score, and probability of survival, but there was no difference between NS and S in scene time or transport time. Of the NS 91.4% died within 7 days; only 8.6% died after 7 days. Central nervous system (CNS) injury was responsible for 48.1% of deaths, followed by hemorrhage (36.8%) and cardiovascular disease (5.7%). Sepsis was responsible for 5.5% of deaths. Secondary brain injury was found at autopsy in 66% of patients dying of CNS injury. The relatively small number of septic deaths may be due, in part, to improvements in treatment associated with regionalization of trauma care. The frequency of secondary brain injury, despite rapid transport and evacuation of mass lesions, suggests that it may play a major role in the pathophysiology of CNS death occurring in a trauma system.