After the report of the Major Trauma Outcome Study, the ACS decided to establish a National Trauma Data Bank (NTDB) for quality improvement and research.Initial effort was focused on selling standard registry software, but growth was slow.After agreeing to accept data from other registry programs, growth was rapid but standardization was a problem.After a standard data format was required, quality improved and quantity did not decrease.NTDB participation has now been mandated for ACS trauma center verification.