Background and objective Injuries are a leading cause of death, significant disability, and utilization of acute medical care. This study describes patterns of acute care services use related to injury and associated costs among children and adolescents in a state Medicaid population. Methods A retrospective, cross-sectional, descriptive research design was used to analyze 2003 West Virginia Medicaid fee-for-service computerized claims for acute care medical services with a primary diagnosis of injury or complication due to injury for recipients below 21 years of age. Medical services utilization rates were calculated and stratified by demographic categories as well as by type of injury. Costs associated with the claims were from the perspective of Medicaid. Results There were 33,599 children who were hospitalized or visited the emergency department for injury or complication due to injury at a rate of 227.2 per 1,000. Children who were white, male, and 15-20 years of age had the highest rate of acute care use by demographic groups. Medicaid paid approximately $7.4 million for injury-related acute care visits. Acute care was mostly delivered in the emergency department, although hospitalizations contributed to one-third of the total costs. The average length of hospital stay for any type of injury or complication due to injury was 4 days. Overall, a diagnosis of traumatic complication was the most frequently occurring, followed by open wounds, contusions, sprains and strains, and fractures. E-codes were not readily recorded. Conclusion The use of injury-related acute medical care varied by demographic variables and diagnosis. Findings from this study can be used as a baseline for further surveillance, and to guide the development of interventions to contain preventable injuries and associated treatment costs.