{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T10:46:31Z","timestamp":1782816391615,"version":"3.54.5"},"reference-count":19,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Resuscitation of traumatic shock (TS) is reflexively oriented towards haemorrhage control, reflecting its contribution to early preventable mortality. While the mechanisms of shock are well established, the relative frequency of haemorrhagic, non\u2010haemorrhagic, indeterminate, and mixed aetiologies in blunt\u2010predominant cohorts is less well characterised. This study aimed to identify and rank the causes of TS among adult major trauma (MT) patients managed at an Australian Level 1 trauma centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study (Dec 2022\u2013Jan 2025) identified MT patients meeting a pragmatic clinical definition of TS based on early physiological parameters. Structured chart review assigned one or more causes of shock using a predefined hierarchy spanning haemorrhagic, non\u2010haemorrhagic, and indeterminate categories. Causes were ranked by frequency and stratified by injury mechanism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 3667 MT patients, 324 (8.8%) met TS criteria. Shocked patients were younger, more severely injured, and had higher in\u2010hospital mortality (22.5% vs. 9.1%). Blunt trauma predominated (86.7%). Pooled haemorrhagic mechanisms accounted for 66.3% of primary aetiologies (64.8% blunt; 76.2% penetrating), leaving approximately one\u2010third of cases attributable to non\u2010haemorrhagic or indeterminate causes. The primary cause was indeterminate in 14.8%, more frequent after blunt than penetrating injury (16.0% vs. 7.1%). Multiple contributory causes were identified in 44.0% of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While haemorrhage remained the dominant aetiology of traumatic shock, approximately one\u2010third of cases\u00a0were\u00a0attributable to non\u2010haemorrhagic, indeterminate, or mixed mechanisms, with these proportions higher following\u00a0blunt injury. These findings argue against an exclusively haemorrhage\u2010centred diagnostic approach in blunt\u2010predominant trauma systems and support routine consideration of alternative and coexisting aetiologies during early resuscitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1742-6723.70286","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T01:15:57Z","timestamp":1779930957000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Aetiology of Traumatic Shock in an\n                    <scp>A<\/scp>\n                    ustralian Level 1 Trauma Centre"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7389-9657","authenticated-orcid":false,"given":"Michael","family":"Noonan","sequence":"first","affiliation":[{"name":"National Trauma Research Institute  Melbourne Australia"},{"name":"Emergency &amp; Trauma Centre The Alfred Hospital  Melbourne Australia"},{"name":"Trauma Service The Alfred Hospital  Melbourne Australia"},{"name":"School of Translational Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fraser","family":"Francis\u2010Pester","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"O'Reilly","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Australia"},{"name":"Emergency &amp; Trauma Centre The Alfred Hospital  Melbourne Australia"},{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2394-682X","authenticated-orcid":false,"given":"Joseph","family":"Mathew","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Australia"},{"name":"Emergency &amp; Trauma Centre The Alfred Hospital  Melbourne Australia"},{"name":"Trauma Service The Alfred Hospital  Melbourne Australia"},{"name":"School of Translational Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2336-1525","authenticated-orcid":false,"given":"Chris","family":"Groombridge","sequence":"additional","affiliation":[{"name":"National Trauma Research Institute  Melbourne Australia"},{"name":"Emergency &amp; Trauma Centre The Alfred Hospital  Melbourne Australia"},{"name":"Trauma Service The Alfred Hospital  Melbourne Australia"},{"name":"School of Translational Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Varma","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine Monash University  Melbourne 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