BACKGROUND: Venous thromboembolism (VTE) is a major preventable complication in trauma patients, with varying incidence and risk factors across populations. AIM/OBJECTIVE: To categorize VTE risk in Korean trauma patients using the Trauma Embolic Scoring System (TESS) and assess the application of prophylaxis by risk level. METHODS: This retrospective study at Korea University Guro Hospital involved 1913 trauma patients over two years. Data on demographics, injury specifics, and preventive treatments were analyzed using TESS. The study examined general, mechanical, and chemical interventions for VTE prevention. RESULTS: Of the patients, 1.4% were diagnosed with VTE. The average TESS score was 3.20, indicating lower injury severity but higher percentages of surgeries over 2 h and serious injuries. The findings showed VTE occurrences even in patients with TESS scores below the high-risk threshold, particularly in limb injuries. Nurse-led interventions like early physical activity were most common in the low-risk group, while mechanical prophylaxis like anti-embolism stockings was also predominantly used in this group. Chemical prophylaxis showed consistent administration across groups, with 37.5% of the high-risk group receiving Low Molecular Weight Heparin (LMWH), although only a minority received it within the recommended 48-hour. CONCLUSIONS: The study reveals a need for vigilant monitoring and intervention across all risk categories, underscoring the importance of tailored VTE prevention guidelines in South Korea. It highlights the role of comprehensive management, including patient education and adherence to updated guidelines. TWEETABLE ABSTRACT: New study categorizes VTE risk in Korean trauma patients using TESS, showing the need for tailored prophylaxis across risk levels #VTEPrevention #TraumaCare.