Operative burden and resuscitation resource utilisation in patients with traumatic shock requiring urgent surgical or endovascular intervention

Patients with traumatic shock represent a high-risk subgroup within major trauma populations, yet the operative burden and resuscitation resource utilisation associated with urgent surgical and endovascular intervention in trauma systems managing predominantly blunt injury remain incompletely described. To describe the epidemiology, resuscitation resource utilisation, and operative burden of patients presenting with traumatic shock who require urgent surgical or endovascular intervention. We conducted a retrospective observational study at an Australian level 1 trauma centre using prospectively maintained trauma registries. Adult major trauma patients (≥ 16 years, Injury Severity Score ≥ 13) meeting institutional shocked trauma activation criteria between December 2022 and December 2024 were included. Resource utilisation, blood product transfusion, operative and endovascular interventions, procedural timing, and critical care outcomes were described. Comparisons were performed between shocked patients requiring urgent surgical or endovascular intervention and those managed without urgent procedures. Of 3667 major trauma patients, 324 (8.8%) met shocked trauma criteria, and 138 (42.6% of shocked patients) underwent urgent surgical or endovascular intervention. These patients demonstrated substantial operative complexity; 37.7% required combined multispecialty interventions with 74.6% undergoing two or more operations within the first seven days. Median time to index urgent intervention was 150 min, and two-thirds of urgent surgical procedures occurred out-of-hours. ICU admission was near universal (94.9%) among patients requiring urgent intervention, with longer ICU LOS (median 8.0 days). Although median transfusion volumes were modest, marked heterogeneity in blood product utilisation was observed. High-volume transfusion (≥ 10 units PRBC within 24 h) occurred more frequently among patients requiring urgent intervention compared with those managed without urgent procedures (25.4% vs. 8.1%, p < 0.001). In a trauma system where blunt polytrauma predominates, patients with traumatic shock requiring urgent surgical or endovascular intervention represent a small but disproportionately resource-intensive cohort. Care is frequently iterative, multispecialty, and delivered out-of-hours, with substantial transfusion and critical care requirements. These findings highlight the need for sustained 24/7 trauma system capability and may inform future strategies for early risk stratification and resource planning in Australian trauma centres.