Objectives: This study examined the relationship between insurance status and emergency department (ED) disposition of injured California children.Methods: Multivariate regression models were built using data obtained from the 2005 through 2009 California Office of Statewide Health Planning and Development (OSHPD) data sets for all ED visits by injured children younger than 19 years of age.Results: Of 3,519,530 injury-related ED visits, 52% were insured by private, and 36% were insured by public insurance, while 11% of visits were not insured. After adjustment for injury characteristics and demographic variables, publicly insured children had a higher likelihood of admission for mild, moderate, and severe injuries compared to privately insured children (mild injury adjusted odds ratio [AOR] = 1.36, 95% confidence interval [CI] = 1.34 to 1.39; moderate and severe injury AOR = 1.34, 95% CI = 1.28 to 1.41). However, uninsured children were less likely to be admitted for mild, moderate, and severe injuries compared to privately insured children (mild injury AOR = 0.63, 95% CI = 0.61 to 0.66; moderate and severe injury AOR = 0.50, 95% CI = 0.46 to 0.55). While publicly insured children with moderate and severe injuries were as likely as privately insured children to experience an ED death (AOR = 0.91, 95% CI = 0.70 to 1.18), uninsured children with moderate and severe injuries were more likely to die in the ED compared to privately insured children (AOR = 3.11, 95% CI = 2.38 to 4.06).Conclusions: Privately insured, publicly insured, and uninsured injured children have disparate patterns of ED disposition. Policy and clinical efforts are needed to ensure that all injured children receive equitable emergency care.ACADEMIC EMERGENCY MEDICINE 2012; 19:541-551 ª 2012 by the Society for Academic Emergency Medicine D espite recent policy efforts to expand insurance coverage for children living in the United States, 1 7.3 million children, or 9.8% of children younger than 18 years, remain uninsured.2 Previous studies have shown that uninsured children have higher in-hospital 3 and trauma mortality rates than insured children. 4,5 However, whether uninsured children receive disparate levels of care in the initial stages of clinical management remains unclear. Here, we investigated the relationship between insurance status and disposition from the emergency department (ED) for injured children. Injury is the leading cause of death for all children 1 year of age and older 6,7 and the ED is the initial location where acutely injured children will typically receive ª