Trauma Patients Research Articles

Viscoelastic coagulation testing in bleeding trauma patients: a retrospective analysis and development of a treatment algorithm.

Comment on "A Retrospective Study of Ultramassive Transfusion in Trauma Patients: Is There a Value After Which Additional Transfusions Are Futile?"

Occult pneumothorax is increasingly diagnosed in trauma patients due to widespread use of computed tomography (CT), yet its optimal management remains controversial. This study aimed to identify clinical and radiological predictors of deterioration requiring tube thoracostomy and to develop a predictive model to guide management decisions. In this retrospective single-centre study, 166 patients with blunt trauma-associated occult pneumothorax were analyzed. Clinical and radiological variables-including subcutaneous emphysema, haemothorax volume, pneumothorax size, mechanical ventilation, and rib fractures-were evaluated for association with delayed tube thoracostomy. A weighted multivariable logistic regression model addressed class imbalance, and model performance was assessed using receiver operating characteristic (ROC) analysis. Of 166 patients, 17 (10.2%) required delayed tube thoracostomy. Subcutaneous emphysema (odds ratio [OR] 20.10, P = .001) and mechanical ventilation (OR 17.30, P = .002) were the strongest independent predictors of deterioration. Haemothorax volume also showed a significant association (OR 1.06, P = .045). Other factors, including pneumothorax size, rib fractures, age, and sex, were not predictive. The predictive model demonstrated excellent discrimination (area under the curve [AUC] = 0.97), suggesting potential for clinical risk stratification. Physiological indicators such as subcutaneous emphysema and mechanical ventilation are superior to anatomical parameters in predicting deterioration among patients with occult pneumothorax. Our findings support a selective management strategy and highlight the utility of predictive modelling to guide tube thoracostomy decisions. Prospective multicentre studies are warranted to validate these results.

Needle of Death Thromboelastography Tracings in Severely Bleeding Trauma Patients: A Novel Predictor of Hemorrhagic Blood Failure and Futile Resuscitation?

Aim To investigate whether regular departmental, in situ simulation in trauma resuscitation improves time to computerized tomography (CT) in real patients presenting to the Emergency Department following major trauma. Methods Ten 30-minute in situ simulation sessions were conducted weekly over 10 weeks, involving Emergency Department staff members who typically form a trauma team. Each session included a 5-minute briefing, a 10-minute scenario and a 15-minute debriefing. Simulations were conducted using a combination of Laerdal MegaCode Kelly manikin with a SimPad Plus control device and iSimulate ALSi Patient Vitals iPad Software. The primary outcome measured was the time from the arrival of a patient into the Emergency Department resuscitation area to CT scan initiation. Results A total of 78 major trauma cases were included (40 pre-intervention and 38 post-intervention). Median time to CT decreased from 73 to 41 minutes – a 43.8% reduction (p = 0.033) – while the mean time decreased from 88 to 61 minutes. The proportion of patients receiving CT within 1 hour increased from 43% to 66% (p = 0.040). Although the proportion scanned within 30 minutes rose from 28% to 45%, this difference did not reach statistical significance (p = 0.262). The distribution of CT times shifted significantly towards earlier imaging post-intervention. Conclusions Regular in situ simulation training significantly reduces the time to CT for actual major trauma patients in the Emergency Department, enhances team performance and improves real-world clinical outcomes.

Background Fractures of the thoracic spine and rib cage frequently occur simultaneously in older trauma patients. The impact of rib fractures in the setting of thoracic spine fractures, and whether multiple thoracic spine fractures is associated with outcomes, remain unclear. This study aimed to evaluate the outcomes associated with either (i) multiple rib fractures or (ii) multi-level thoracic spine fractures in older adults with at least one thoracic spine fracture. Methods We conducted a retrospective cohort study to identify patients aged ≥65 years with at least one non-operatively managed thoracic spine fracture managed at an Australian Major Trauma Service between 2016 and 2021. Patients were divided into four groups based on injury profile – single-level or multi-level thoracic spine fractures, either with (R+) or without (R−) concurrent multiple rib fractures. Multi-variable regression was used to evaluate the association of rib fractures and multi-level thoracic spine fractures (controlling for the reciprocal injury and demographic variables) with outcomes. Outcomes included hospital length of stay (LOS), discharge destination, 6-month residential status and 12-month mortality. Results In total, 409 patients had at least one non-operatively managed thoracic spine fracture. A total of 121 (29.6%) had multi-level thoracic spine fractures, and 98 (24.2%) had multiple rib fractures. After adjusting for associated factors and the presence of multiple rib fractures, multi-level thoracic spine fractures were associated with a 21% increase in hospital LOS (geometric mean 1.21, 95% confidence interval (CI) 1.05–1.40, p = 0.005) and more than double the odds of 12-month mortality (odds ratio 2.6, 95% CI 1.3–5.2, p = 0.008). In contrast, multiple rib fractures were not associated with any measured outcomes, even with the influence of multi-level thoracic spine fractures controlled for. Conclusion Multi-level thoracic spine fractures, irrespective of the presence of multiple rib fractures, were associated with an increase in hospital LOS and 12-month mortality in older adults with at least one thoracic spine fracture.

Surgical management of cervical spinal fractures accompanying ankylosing spondylitis (ASCSF) is intractable in clinical practice. There is still debate about whether surgery by a single-anterior approach is enough for treating ASCSF. The purpose of this study is to summarize and share relevant experience and lessons from both our team and the literature. Patients referred to our center for ASCSF following single-anterior surgery (from January 2008 to December 2020) were distinguished and enrolled. In addition, literature published from 2000 to 2021 on PubMed and Web of Science databases was systematically reviewed. A total of 63 patients (7 from our center and 56 from the literature) who underwent single-anterior surgery for treating ASCSF were brought into this study. The average follow-up time of patients in our center is 44 months. The average age of all patients was 58.6. C6/7 was the most commonly injured level (22 patients, 34.9%), and 44 patients (69.8%) experienced neurological impairment at admission. Most ASCSF patients have lordotic cervical alignment and minimal displacement of the fracture. A total of 8 patients died at an early stage after surgery. Apart from these 8 cases, the incidence rates of general complications and surgical complications were relatively 10.9% and 20.0% respectively. The incidence analysis revealed pneumonia (5.45%) as the predominant general complication, contrasting with implant failure (14.55%), which emerged as the most common surgical complication. Among the 8 cases (14.55%) demonstrating implant failure, radiographic analysis revealed preserved cervical lordosis in 4 patients (50%), kyphotic deformity in 1 patient (12.5%), while cervical alignment data were unavailable for the remaining 3 cases (37.5%). Moreover, 29 patients (52.7%) achieved improvement, and 18 patients (37.5%) maintained stable neurological function. For most ASCSF patients with preserved lordotic alignment and minimal displacement, a single anterior surgery can achieve significant neurological improvement and result in a relatively lower incidence of complications. This provides a good basis for orthopedic physicians to handle cervical spine trauma patients with ankylosing spondylitis.

Introduction: High-quality palliative care in trauma intensive care units is crucial but often hindered by prognostic uncertainty, time constraints, limited provider training, and cultural differences between acute care surgery and palliative care services. In response, the American College of Surgeons Committee on Trauma recommends early goals-of-care discussions for high-risk trauma patients. However, little is known about how these strategies are implemented in practice. We aimed to identify communication strategies in trauma critical care and evaluate their impact on patient and family-centered care. Methods: We conducted a literature search of PubMed, Embase, CINAHL, and Web of Science for studies published through October 2024. Inclusion criteria focused on adult trauma or surgical ICU patients and studies addressing palliative care, communication strategies, or goals-of-care discussions. Data from eligible studies were extracted and synthesized qualitatively, with themes identified using grounded theory analysis. Results: We identified 39 eligible studies. Thematic analysis identified five key themes: communication frameworks, interdisciplinary approaches, communication barriers, provider education, and impact on patient and family satisfaction. Communication frameworks including structured family meetings, use of communication checklists, and decision aids such as the Best Case/Worst Case Scenario tool improved shared decision-making. Several studies emphasized the importance of shared responsibility for patients between palliative care specialists and trauma providers. Conclusions: Evidence suggests that structured communication frameworks and early interdisciplinary involvement improve family satisfaction and patient-centered outcomes. Despite progress, standardized approaches to palliative communication in trauma ICU settings remain a challenge. Future efforts should focus on targeted education and standardized protocols.

Traumatic rib fractures in high-risk patients present significant challenges in pain management, with inadequate analgesia leading to pulmonary complications, prolonged hospitalization, and increased morbidity. Conventional pain management strategies, including opioid-based regimens and catheter-based regional anesthesia, have undesirable side effects and limited duration analgesia. Cryoneurolysis overcomes many of these limitations and provides more sustained analgesia that better aligns with the expected prolonged pain trajectory of traumatic rib fractures. This brief technical report and case series details a description of our ultrasound technique we employ for percutaneous cryoneurolysis of intercostal nerves to achieve potent analgesia for traumatic rib fractures. We describe five cases of severe, high-risk traumatic rib fractures, as defined by a Rib Fracture Score >6 and STUMBL Score ≥26, who received ultrasound-guided, percutaneous cryoneurolysis of intercostal nerves for analgesia. Following cryoneurolysis, all patients showed significant clinical improvements, including better pain scores, reduced opioid consumption, rapid weaning from supplemental oxygen, and accelerated rehabilitation toward hospital discharge. Ultrasound-guided, percutaneous cryoneurolysis represents a promising, minimally invasive technique for managing pain associated with traumatic rib fractures in high-risk patients. The procedure offers sustained analgesia, improved respiratory function, and reduced systemic analgesic requirements while maintaining a favorable risk-benefit profile.

Objective To compare three therapeutic strategies in the management of acute post-traumatic pain at emergency department (ED) discharge. Methods We conducted a prospective, randomized, controlled trial including patients ≥18 years with acute post-traumatic pain. They were randomized to receive oral paracetamol (n = 506), paracetamol-codeine (P-Cod group; n = 489) and paracetamol-caffeine (P-Caf group; n = 505) for 7 days. The primary endpoint was the rate of participants achieving at least 50% reduction in Numerical Rating Scale (NRS) from baseline by the 7th day after ED discharge. Secondary endpoints included the need for rescue analgesics, adverse effects, and patient satisfaction. Results At day-7, success rate were 85.8%, 93.9%, and 90.1% in paracetamol, P-Cod, and P-Caf groups, respectively. The differences were statistically significant between the paracetamol and P-Caf groups (p = .02), the paracetamol and P-Cod groups ( p ≤ .001); and the P-Cod and P-Caf groups ( p = .04). The need for rescue analgesics was significantly higher in paracetamol group (47.6%) compared to P-Caf (7.5%) and P-Cod group (7.4%); whereas, no significant difference was found between P-Cod and P-Caf groups. Most of the adverse effects (95.7%) were observed in P-Cod group. Finally, patients treated with paracetamol alone were the least satisfied. Conclusion The combination of codeine or caffeine with paracetamol was equally effective and superior to paracetamol alone. If we consider the better tolerance, paracetamol combined with caffeine appears to be a suitable analgesic option for post trauma patients.

Introduction: In-Transit cardiac arrest in trauma patients, although infrequent, is a critical event with high mortality. Accurate prediction of this event at emergency medical services (EMS) contact is essential for timely interventions. Objective: To develop and validate a simplified predictive score to estimate the risk of cardiac arrest during transportation in trauma patients, using data available at the time of EMS contact. Methods: We analyzed data from the Japan Trauma Data Bank (JTDB) between 2019 and 2023. The study population consisted of trauma patients with an Abbreviated Injury Scale (AIS) score ≥ 3 who did not have cardiac arrest on arrival of EMS. Patients with burns, AIS score of 6, or missing data were excluded. The primary endpoint was in-transit cardiac arrest. Patients were divided into a development cohort (2019-2022) and a validation cohort (2023). A multivariable logistic regression model was used to develop the score from the development set. The coefficients were simplified by rounding to generate an integer-based scoring system. Model performance was evaluated using 10-fold cross-validation in the development set and external validation in the validation set. Results: Among 176,054 trauma patients, 66,569 patients were analyzed (development: 53,537; validation: 13,032). In-transit cardiac arrest occurred in 0.30% (160/53,537) of the development cohort and 0.35% (45/13032) of the validation cohort. The scoring formula is shown in Figure A. The area under the receiver operating characteristic curve (AUC) of the score was 0.89 (95% CI: 0.85–0.92) in the development set and 0.88 (95% CI: 0.83–0.94) in the validation set (Figure B). In both the development and validation cohorts, the incidence of in-transit cardiac arrest increased with higher score categories: 0.1% (34/48,189) and 0.1% (9/11,758) for scores of ≤0; 0.6% (15/2,375) and 1.4% (8/568) for scores 1–2; 1.1% (8/725) and 1.1% (2/178) for scores 3–4; 2.6% (30/1,165) and 2.2% (6/276) for scores 5–6; and 6.7% (73/1,083) and 7.9% (20/252) for scores ≥7 (Figure C). Conclusions: We developed and validated a simplified predictive score to estimate the risk of cardiac arrest during transport in trauma patients, Predictable Trauma Death (PTD) Score. Patients with a score ≥7 had a risk exceeding 5%, suggesting that preemptive preparations for possible cardiac arrest should be considered in this group.

Introduction: Haemorrhagic shock is the one of the leading causes of death in trauma patients and early recognition of blood loss, haemorrhage control and rapid massive transfusion is lifesaving [1]. Efficient delivery of blood products is essential to the care of trauma patients [2] and is dependent on excellent multi-disciplinary teamwork and communication. In our institution, a Dublin based designated Trauma Unit, we sought to investigate the effect of multi-disciplinary simulation based medical education on time to delivery of blood products in a massive transfusion. Methods: Four multi-disciplinary team (MDT) simulation based medical education training sessions were held between 2020 and 2022. The MDT included prehospital National Ambulance Service, emergency department medical and nursing staff, porters, health care assistants, surgical and intensive care doctors and blood bank staff. Each simulation was based on a major trauma and used a standardised massive transfusion protocol. To evaluate the efficacy of the MDT simulation-based training, a retrospective review was carried out which analysed the; i) Activation of the massive transfusion protocol, ii) time to issue pack one, and, iii) time for pack one to be collected from the lab. Results: Prior to the MDT simulation-based education the average time from activation of the MTP to the blood arriving in the emergency department was in excess of 40 minutes. After conducting the training, the time decreased to 32 minutes. The average time from activation of the MTP to issuing pack one was 13 minutes and from issuing the blood to delivery to the emergency department was 20 minutes which was a significant improvement on the pre-training times. Discussion: We demonstrated a reduction in time to delivery of blood products associated with regular MDT in situ simulation training. Deliberate practice of the massive transfusion protocol improved teamwork and communication which lead to a reduction in time taken for the delivery of blood products. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Description of Case: A 33-year-old previously healthy male presented with profound shock following a motor vehicle accident. Initial trauma workup revealed a sternal fracture and a large retrosternal hematoma in the anterior mediastinum measuring 1.4 x 4.1 x 14.0 cm along with right fourth and fifth anterior rib fractures. Imaging was negative for aortic dissection. On examination, he was found to have a loud holosystolic murmur at the left lower sternal border. TTE revealed a large muscular, non-restrictive ventricular septal defect (VSD) with predominant left-to-right shunt, a dilated and hypokinetic right ventricle, and no pericardial effusion. Cath confirmed a 2:1 left-to-right shunt, elevated filling pressures, RV failure, and normal coronaries. Given the presence of hemodynamic instability and VSD-related RV failure, cardiac surgery and interventional cardiology teams recommended Emergent VSD repair and temporizing mechanical circulatory support (MCS). An Impella CP device was successfully placed via the right femoral artery. The patient was stabilized for potential surgical repair and transferred to higher level of care for emergent VSD repair where he underwent surgical repair and was eventually taken off the MCS. Discussion: Traumatic ventricular septal defect (VSD), first described by Hewett in 1847 remains a rare but serious complication of blunt chest trauma - Parmley et al. reported only 5 cases among 5,467 patients in a 1958 review. It typically results from anteroposterior compression during early systole, when the ventricles are full and AV valves closed, stressing the septum. Most occur in the muscular septum near the apex, as in our patient. Prognosis correlates with defect size and shunt severity - Rotman et al. reported 25% mortality in defects <2 cm, rising to 71% in larger ones. A Qp:Qs ratio >2:1, as in our patient, indicates a significant left-to-right shunt and warrants urgent intervention, especially with right heart failure or poor perfusion signs. Smaller, asymptomatic defects may be managed conservatively, as many close spontaneously. However, larger or symptomatic VSDs, especially those diagnosed within 48 hours post-injury, are associated with higher mortality and typically necessitate surgical or percutaneous closure. In addition, this case highlights the importance of thorough physical exam and high clinical suspicion for traumatic VSD in trauma patients with unexplained shock or new murmurs, especially with chest wall injuries.

Urethro-rectal fistulas associated with pelvic fractures represent rare but devastating injuries that create abnormal communications between the urinary and gastrointestinal tracts. These complex injuries typically affect young male trauma patients and require a staged, multidisciplinary approach to management. This review examines epidemiology, pathophysiology, diagnostic workup, and management strategies for these injuries. Both conservative and surgical approaches are discussed, along with expected complications and long-term outcomes. While anatomical success rates are high with modern surgical techniques, functional outcomes remain challenging, with many patients experiencing erectile dysfunction and urinary incontinence. Current evidence suggests that a staged approach with initial diversion followed by delayed definitive repair optimizes outcomes for most patients. With comprehensive care, even patients with urethro-rectal fistulas in pelvic fracture can achieve meaningful recovery.

Out-of-hospital traumatic cardiac arrest (TCA), caused by severe injuries such as blunt or penetrating trauma, is associated with extremely low survival rates. Around 2.7% of trauma patients experience cardiac arrest on scene, with an overall survival rate below 5%. The impact of hospital level and transport distance on TCA outcomes remains unclear. This study aimed to assess whether transport to hospitals of different levels and distances is associated with return of spontaneous circulation (ROSC), survival to admission, and 30-day survival. We conducted a retrospective study of adult TCA patients transported to emergency departments in Taoyuan City from January 2016 to December 2022. Patients were divided into three groups: those transported to a trauma center (TC), to the nearest non-trauma center (non-TC), or cross-regionally to a TC. Geographic information system (GIS) data were used to determine hospital locations and distances. Multivariable logistic regression was performed to analyze associations between transport destination and clinical outcomes. A total of 557 patients were included (TC: 190 [72 direct, 118 cross-regional]; non-TC: 367). The TC and cross-region TC groups had higher ROSC rates (30.6% and 30.5%, respectively) and lower mortality (95.8% for both) than the non-TC group (ROSC 12.0%, mortality 99.5%). Multivariable analysis showed that direct TC transport (aOR 2.91, 95% CI 1.54–5.49) and cross-regional TC transport (aOR 2.05, 95% CI 1.01–4.15) were significantly associated with better outcomes. Blunt trauma was independently associated with worse survival (aOR 0.31, 95% CI 0.08–0.78). Transport to a TC—either directly or across regions—is associated with improved survival in TCA. The current policy prioritizing the nearest hospital may lead to worse outcomes. Within 10 km, bypassing non-TCs in favor of TCs may be beneficial. Blunt trauma is linked to poorer prognosis compared to other mechanisms.

Globally, traditional bonesetters (TBSs) often provide patients with care for their orthopaedic concerns, from musculoskeletal injuries to oncological pathologies, often using techniques that may differ from Western methods. The aim of this study was to investigate the motivations for seeking care from a TBS, the types of treatments received, and the attitudes toward traditional bonesetting, and to determine any differences between patients with traumatic versus nontraumatic musculoskeletal pathologies. We surveyed patients who presented to the Orthopaedic Outpatient Clinic at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda, who had previously seen a TBS for their orthopaedic concern, in order to determine their reasons for seeking care from a TBS and the impressions of their care. This study included 168 patients: 109 presented with traumatic injury, and 59 presented with another orthopaedic concern. The trauma group had a higher monthly family income (p < 0.001) and a higher level of education (p = 0.006) than the nontrauma cohort. Treatments provided by the TBS included cutting or puncturing of the skin, locally applied herbs, casting, and other traditional methods. The greatest motivation for seeking traditional bonesetting among trauma patients was belief in its efficacy; the patients in the nontrauma cohort believed that a TBS could reverse the witchcraft or curse that had caused their ailment. Failure of management was the reason that was cited most by both the trauma and nontrauma groups for discontinuing treatment with a TBS. Orthopaedic pathology influences the way that individuals seek traditional bonesetting and their motivations for doing so. For nontraumatic pathologies, superstitious beliefs and a belief in its efficacy play a role in the selection of traditional bonesetting. Additional surveys of individuals may further elucidate the outcomes of seeking care from a TBS. Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

Early identification of hypofibrinogenemia in major trauma: The usefulness of the FiT-6 (Fibrinogen in Trauma-6) score.

Background: Incomplete documentation of diagnostic imaging in discharge summaries is a recognised patient safety risk, particularly in orthopaedics, where radiological findings often guide management. Omission of imaging results can lead to duplicated investigations, delayed recognition of complications, and missed follow‑up. This audit evaluated the quality of imaging documentation in elective orthopaedic discharge summaries and assessed the impact of a targeted intervention.Aim: To improve the inclusion of diagnostic imaging results on discharge summaries for elective orthopaedic inpatients.Methods: A retrospective clinical audit with a re‑audit cycle was conducted on the elective orthopaedic ward at University College London Hospitals. The first cycle (1st to 31st July 2025) reviewed discharge summaries of all adult elective orthopaedic inpatients who underwent radiological investigations. Exclusion criteria were trauma admissions and patients without imaging. Data were extracted from the electronic patient record and radiology reporting system, recording whether imaging performed during admission was referenced in the discharge summary. Following the first cycle, an educational poster highlighting audit findings and national standards was disseminated to ward doctors. The introduction of the structured template with a mandatory “diagnostic imaging” section was also introduced. A re‑audit (1st to 30th September 2025) assessed the impact of this intervention. The primary outcome was the proportion of discharge summaries referencing relevant imaging results.Results: In the first cycle, none of the 144 eligible discharge summaries (0%) documented imaging results. Following ward doctor education and the introduction of the structured template with a mandatory “diagnostic imaging” section, compliance improved to 93%.Conclusion: Embedding a dedicated diagnostic imaging section within discharge summaries eliminated omissions and ensured consistent communication of radiological findings. This simple, speciality-specific intervention directly addressed a critical documentation gap in orthopaedics and represents a scalable, evidence‑based strategy to strengthen clinical handover and improve patient safety.

Background and Objectives: The mechanisms of traumatic brain injury (TBI), patient characteristics, and long-term outcomes in elderly patients differ from those in other age groups. This study aims to evaluate the effectiveness of the Elderly Traumatic Brain Injury (eTBI) Scoring System, recently described in the literature, in predicting mortality, prognosis, and surgical indication. Materials and Methods: Patients diagnosed with TBI over the age of 65 between January 2017 and December 2024 were retrospectively analyzed, and their eTBI scores were calculated. Statistical analyses were conducted to assess mortality, prognosis, and surgical indication or benefit from surgery across low-, medium-, and high-risk groups. Results: In this cohort of 236 patients, the mortality rate was higher in the high-risk group according to the eTBI scoring system, compared to the medium- and low-risk groups. However, the scoring system does not appear to be effective in determining surgical indications. While the medium-risk group was most predictive of mortality, the low-risk group demonstrated better accuracy in predicting prognosis. Conclusions: The eTBI scoring system appears to be an effective tool for assessing mortality risk and predicting prognosis in specific subgroups of elderly TBI patients.

Background/Objectives: Transarterial embolization nowadays has a pivotal role in non-operative management strategies of post-traumatic bleeding. Timely control of hemorrhage is critical in trauma care; however, the impact of procedural timing remains underexplored. This single-center study, conducted at a Level II trauma center with 24/7 interventional radiology coverage, evaluated the influence of interval time on embolization outcomes in post-traumatic bleeding patients. Methods: In this retrospective study, 182 trauma patients who underwent embolization between June 2020 and June 2025 were analyzed. Patients were stratified by CT-to-angiography interval time (≤1 h [early, n = 46] and &gt;1 h [delayed, n = 136]). Hemodynamic parameters, laboratory values, transfusion needs, and outcomes were compared and adjusted for baseline differences. Results: Early group patients showed more severe baseline physiology, including hypotension, higher lactates, and lower hemoglobin. No significant differences were found in mortality (2.9% vs. 2.5%), hospital stay (18.7 ± 26.1 vs. 18.1 ± 22.2 days), or transfusion requirements. Embolizations within one hour from CT were associated with significant lactate reduction at 24 h in univariate analysis (p = 0.039), but this was not confirmed in multivariate analysis. Re-embolization (8.7% vs. 1.5%, p = 0.036) and surgical rescue (13.0% vs. 3.7%, p = 0.033) rates were more frequent in the early group. Conclusions: Early embolization improves metabolic parameters in post-traumatic bleeding, especially in patients with greater baseline severity of injuries. These findings support prioritization of early embolization and structured interventional radiology networks for timely procedures. A personalized approach according to baseline injury is required.