Background: Motor vehicle crashes (MVCs) are the leading cause of death for ages 2-34 years. Rollover (RO) is defined as any vehicle rotation of ≥90° about any longitudinal or lateral axis occurring. The purpose of this study was to determine the cost effectiveness of RO mechanism as the sole triage criteria.Methods: Detailed patient injury, demographics, costs and crash information were obtained on patients ≻16 years and seen at an ACS COT-verified level I trauma center from 2007-2008. Analysis was performed using SPSS v 17.Results: 257 RO crash occupants were treated at this study center. The frequency of AIS ≤2 in these RO occupants was 74%. 62% (133/214) of patients triaged as partial TTA (PTTA) were discharged from the emergency department (ED), whereas all full TTA (FTTA) patients were admitted. 60% of all RO patients were reported to have utilized seat belts. Seat belt use decreased the risk of injury by four-fold (95% CI, 2.14-8.01). No other patient or crash characteristics contributed to this excess triage rate. Based on an average cost of $6,000/TTA and our excess ED discharge rate exceeding the accepted national average rate of 37%, this trauma center could save $498,000/year. Applying the same cost analysis to the NASS database could save $190 million annually to the trauma systems nationally.Conclusion: Consideration of physiometric data, and seat belt use in the triage of non-critically injured RO occupants could potentially save this trauma center up to $2.5 million over a five-year period and approximately $0.95 billion dollars for the trauma systems nationwide over the same period.