Background: Alcohol and substance use is prevalent in trauma patients admitted to hospital. Aim: Investigate the association between hospital admission and substance use for three different injury types among trauma patients according to age and gender. Method: Prospective cross-sectional emergency department study. The patients were divided into injury groups and compared with respect to gender, age, hospital admission, substance use, and blood alcohol level. Results: The study included 998 trauma patients, of whom 39% screened positive for substance use. Patients with head injury had a higher prevalence of alcohol use (29%). Patients with head injury and hazardous drug or alcohol use were less likely to stay in hospital for more than 24 hours (adjusted OR: 0.61, 95% CI: 0.41–0.93,p = .02), whereas patients with injuries to neck/thorax/abdomen and hazardous use had the highest risk of staying in hospital more than 24 hours (adjusted OR: 5.22, 95% CI: 1.47–18.76,p = .01). Injuries to pelvis/extremities were more common among women with medicine use. Conclusion: Patients with head injury and hazardous use were less likely to be admitted to hospital, whereas patients with injuries to the neck/thorax/abdomen and hazardous use were more likely to be admitted. [ABSTRACT FROM PUBLISHER]