Introduction: The analysis of traumatic mortality helps us evaluate critical points in the care of this type of patient, and its identification allows for changes and improvements in their treatment. This is of vital importance in places where there is no trauma system. This study aims to characterize the epidemiology of patients who died from trauma in a reference hospital for this type of patient. Methodology: Retrospective and descriptive study that includes all patients who died from trauma over 15 admitted to the trauma registry between 2018 and 2021. Results: A total of 174 patients who died from severe trauma and managed to receive hospital care were analyzed. The included patients represent an overall mortality of 3%. The primary mechanism of trauma was blunt 61 vs 39% penetrating. Around 44% of the total deaths were secondary to traffic accidents. The leading cause of death during the first hours of care was hemorrhage due to penetrating trauma. In addition, the sample highlights high mortality from traumatic brain injury (TBI) in the resuscitation area. Conclusion: The epidemiological description of mortality due to severe trauma in a highly complex hospital allows the identification of critical points within care. In our cohort, the rapid mortality from penetrating trauma and the high mortality from TBI in the resuscitation area represent a lack of regionalization and a need to improve the prehospital system around a trauma system.