Objective To describe the association between increasing age, pre-hospital triage destination compliance, and patient outcomes for adult trauma patients. Methods A retrospective data review was conducted of adult trauma patients attended by Ambulance Victoria (AV) between 2007 and 2011. AV pre-hospital data was matched to Victorian State Trauma Registry (VSTR) hospital data. Inclusion criteria were adult patients sustaining a traumatic mechanism of injury. Patients sustaining secondary traumatic injuries from non-traumatic causes were excluded. The primary outcomes were destination compliance and in-hospital mortality. These outcomes were evaluated using multivariable logistic regression. Results There were 326,035 adult trauma patients from 2007 to 2011, and 18.7 met the AV pre-hospital trauma triage criteria. The VSTR classified 7461 patients as confirmed major trauma (40.9 > 55 years). Whilst the trauma triage criteria have high sensitivity (95.8 ) and a low under-triage rate (4.2 ), the adjusted odds of destination compliance for older trauma patients were between 23.7 and 41.4 lower compared to younger patients. The odds of death increased 8 for each year above age 55 years (OR: 1.08; 95 CI: 1.07, 1.09). Conclusions Despite effective pre-hospital trauma triage criteria, older trauma patients are less likely to be transported to a major trauma service and have poorer outcomes than younger adult trauma patients. It is likely that the benefit of access to definitive trauma care may vary across age groups according to trauma cause, patient history, comorbidities and expected patient outcome. Further research is required to explore how the Victorian trauma system can be optimised to meet the needs of a rapidly ageing population.