Project Abstract Pediatric traumatic brain injury (TBI) is a public health crisis in the U.S. and worldwide. Adherence to the Brain Trauma Foundation Guidelines for the care of infants and children with acute TBI improves pediatric TBI outcomes but does not address additional outcome improvements that could be achieved by considering equity in acute TBI care. Addressing disparities in acute TBI care represents an important unmet need. We leverage the availability of the Pediatric Guideline Adherence and Outcomes (PEGASUS) program and ongoing randomized controlled trial and propose a one-year project to achieve equitable acute pediatric TBI care. The overarching aim is to incorporate an anti-racism lens to strengthen equitable implementation of the PEGASUS program for use by Level I and Level II U.S. trauma centers. The two Specific Aims are: 1) To characterize racial/ethnic disparities in acute pediatric TBI care and 2) To identify barriers, facilitators, and strategies to achieving equitable acute pediatric TBI care provision. An expected outcome of the proposed research is a PEGASUS equity assessment toolkit that Level I and II trauma centers can use to improve equitable implementation of the PEGASUS program in the United States.