Introduction Multiple studies have reported higher in-hospital mortality rates among geriatric trauma patients. However, there is a notable lack of data regarding out-of-hospital mortality in severely injured elderly trauma patients. Objectives The primary objective of this study is to evaluate cumulative mortality rates (in-hospital, 28-day, 1 year, 2 year, 3 year after trauma) in severely injured elderly trauma patients. Independent risk factors for 1-year mortality are evaluated. Patients and Methods Retrospective analysis of all patients ≥65 years with an injury severity score (ISS) ≥16 points (Study period 01/2017 to 12/2022). Demographic details, injury pattern (Abbreviated Injury Scale (AIS) scores, ISS), as well as mortality rates at the various time-points were extracted from the electronic patient files. Patients were further stratified into two age groups: 65-80 years and >80 years at the time-point of trauma. Results A total of 1189 patients ≥65 years with an ISS≥16 (mean ISS 24.3±7.9) were identified (AIS head ≥3 in 70.6%, AIS chest ≥3 in 28.2%, AIS extremity ≥3 in 17.4% of patients). The overall in-hospital mortality rate was 10.3%. The 28-day, 1-, 2- and 3-year mortality rates were 15.8%, 26.5%, 31.5%, and 36.3%, respectively. Stratified by age groups, in-hospital mortality in patients 65-80 vs. >80 years was 9.5% vs. 11.8% (p 0.227), mortality at 28-day was 11.9% vs. 22.6% (p<0.001), at 1 year 18.9% vs. 39.6% (p<0.001), at 2 year 22.8% vs. 46.5% (p<0.001) and at 3 year after trauma 24.9% vs. 56.4% (p<0.001). The single independent risk factor for mortality 1 year after trauma was severe head injury (AIS head ≥3, p<0.001). Conclusion One year after severe trauma, the mortality rate in elderly patients is high at 26.5%. In patients >80 years at the time-point of trauma, 1-year mortality was almost 40%. These findings highlight the importance of tailored management strategies in these patients in-hospital, but also post-discharge and in rehabilitation.

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