The objective of this study was to identify predictors of acute-care treatment costs and length of stay for patients with traumatic spinal cord injury (TSCI). The project involved a record linkage study of healthcare utilisation and costs over a 3 year period for a group of patients aged 16 years or more with incident TSCI in New South Wales. Generalised Linear Model regression was used to identify predictors of higher acute care treatment costs for patients with TSCI. Scenario analysis quantified the proportionate cost impacts of patient pathway modification. Direct transfer to SCIU for patients with acute TSCI resulted in lower treatment costs, shorter length of stay, and less costly complications. Modeling showed that optimising patient-care pathways can result in significant acute-care cost savings.