BACKGROUND: It is well documented that houseless patients tend to have worse medical outcomes; however, the interaction between housing status and traumatic injury, particularly in pediatric patients, is not well-understood. In this study we sought to identify if houseless patients have greater morbidity and mortality after trauma utilizing the years 2022-2023 of the Trauma Quality Improvement Program (TQIP) database. METHODS: We conducted a case-control study utilizing years 2022-2023 of the TQIP database, matching pediatric houseless patients in a 1:3 proportion to housed patients by admission year, age, sex, and ISS. Multinomial logistic regression modeled the relationship between housing status and discharge disposition, and structured generalized linear mixed models assessed differences in length of stay and likelihood of any hospital complication. RESULTS: 453 houseless patients were compared to 1359 controls. Significantly more houseless patients died (5.7 %) compared to controls (3.7 %). On multivariable analysis, houseless patients had over double the likelihood of death compared to discharge home (aOR 2.19), 58 % greater odds of transfer for additional care (aOR 1.58), with no significant difference in complications or resource utilization (LOS, ICU LOS, ventilator days). Identifying as a person of color doubled the odds of mortality (aOR 2.01) and increased odds of hospital complications by 76 % (aOR 1.76). CONCLUSIONS: Caring for pediatric houseless patients presents a difficult balance between treating physical injuries while addressing social issues. Addressing the increased odds of mortality after trauma among the houseless children described in this report begins with funding social programs dedicated to preventing houselessness in the community. STUDY TYPE: Prognostic and Epidemiological; Level IV.