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Patient outcomes are presumed to vary during early implementation of a trauma system because of fluctuations in processes of care. This study estimates risk-adjusted survival for injured geriatric patients during implementation of the Washington State trauma system.A presystem (1988–1992) versus early construction phase (1993–1995) retrospective cohort analysis of hospitalized geriatric injured patients in Washington State was conducted. Hospital data were cross-linked to death certificates, providing patient follow-up. A Cox proportional hazards model assessed survival to 60 days from hospital admission.A total of 77,136 geriatric patients were assessed. No difference in survival was observed (before vs. after) for all geriatric injured patients. However, among severely injured patients (Injury Severity Score > 15), survival during the implementation phase increased by 5.1% compared with patients admitted during the presystem years (p = 0.03).This study demonstrates improved survival for seriously injured geriatric trauma patients during construction of the Washington State trauma system.