Objective To analyze the factors affecting the prognosis of elderly patients with severe craniocerebral injury.Methods Retrospective analysis of the clinical data of 1 047 elderly patients with severe craniocerebral injury admitted to the department of neurosurgery of Tianjin First Central Hospital from January 1997 to December 2021,including gender,Glasgow coma scale(GCS),injury factors and injury types,and treatment after admission.According to Glasgow outcome scale(GOS),good condition,mild disability,severe disability are considered as effective treatment,while persistent vegetative state and death are considered as ineffective treatment.Univariate and multivariate Logistic analysis of risk factors affecting the prognosis of patients with severe craniocerebral injury.Results Among the 1 047 patients,612(58.45%)were effectively treated,and 435(41.55%)were ineffective.The inefficiency of treatment in patients with intracranial hematoma was significantly higher than that of patients without intracranial hematoma[53.8%(342/636)vs.22.6%(93/411)],the treatment inefficiency of patients with complex injuries was significantly higher than that of patients with simple craniocerebral injury[62.4%(249/399)vs.28.7%(186/648)],the treatment inefficiency of patients with GCS scores of 3-5 was significantly higher than that of patients with GCS scores of 6-8[64.8%(243/375)vs.28.6%(192/672)],all differences were statistically significant(all P<0.05).There was no significant difference in the treatment inefficiency between males and females,or between patients with and without skull fractures[42.2%(294/696)vs.40.2%(141/351)and 37.9%(69/182)vs.42.3%(366/865),respectively,all P>0.05].Multivariate Logistic analysis showed that intracranial hematoma[odds ratio(OR)= 2.266,95%confidence interval(95%CI)was 1.656-3.103],type of injury(OR = 1.816,95%CI was 1.279-2.578)and GCS score(OR = 2.262,95%CI was 1.582-3.234)were independent prognostic factors for elderly patients with craniocerebral injury(all P<0.05).Conclusion To reduce the morbidity and mortality,it is crucial to address the factors that impact the prognosis of elderly patients with severe craniocerebral injury,by reducing the occurrence of intracranial hematoma and multiple injuries,as well as closely monitoring GCS scores,patient outcomes can be improved to a certain extent.