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Ventilator associated pneumonia (VAP) rate has been tracked as a comparable quality measure but there is significant variation between types of ICUs. We sought to understand variability and improve its utility as a marker of quality. The National Trauma Database was surveyed to identify risk factors for VAP. Logistic regression, χ , Student's T-test or Mann-Whitney U test were used. Risk factors associated with developing VAP were injury severity score (ISS) (OR 1.03, 95% CI 1.03 -1.04), prehospital assisted respiration (PHAR) (OR 1.10,