What are potential research topics in Trauma and Surgical Critical Care?

Research Topics in Trauma and Surgical Critical Care

Trauma and surgical critical care offers numerous high-impact research opportunities focused on improving morbidity, mortality, and quality of life through optimization of acute interventions, systems of care, and patient-centered outcomes. 1, 2

High-Priority Research Areas

Geriatric Trauma Management

• Undertriage in older adults represents a major research priority, as geriatric patients are 5 times more likely to die from trauma compared to younger victims despite similar injury patterns 1
• Investigate physiologic responses to injury that differ in elderly patients, including altered hemodynamic parameters and coagulation profiles 1
• Develop and validate novel criteria to identify serious injury in older adults beyond traditional scoring systems 1
• Examine frailty assessment tools and their integration into trauma triage protocols to reduce undertriage 1
• Study optimal resuscitation strategies in elderly patients with preexisting comorbidities (80% have at least one chronic disease) 1

Nutritional Optimization in Critical Illness

• Protein delivery in mechanically ventilated trauma patients requires urgent investigation, as current practice delivers only 0.6 g/kg/d versus the recommended 1.2-2.0 g/kg/d 1
• Examine whether higher protein doses improve outcomes or potentially worsen them, as recent trials suggest conflicting results 1
• Investigate optimal timing and composition of enteral nutrition in trauma patients with 20-50% greater energy expenditure than elective surgical patients 1
• Study immunomodulatory supplementation strategies to reduce infection susceptibility in catabolic trauma patients 1

Hemorrhage Control and Hemostatic Technologies

• Evaluate safety and efficacy of emerging hemostatic technologies for control of life-threatening bleeding in civilian settings 1, 3
• Investigate optimal tourniquet duration and criteria for safe release, balancing lives saved versus limb ischemia complications 1, 3
• Study hemostatic dressing effectiveness when standard direct pressure fails in prehospital settings 1
• Examine point-of-care lactate testing and tissue oxygenation monitoring for early hemorrhagic shock detection 1

Traumatic Brain Injury Management

• Research neuroprotective therapies including therapeutic hypothermia with focus on timing, duration, degree of cooling, and patient selection 1
• Investigate novel agents with preclinical evidence for neuroprotection, particularly with concomitant recanalization strategies 1
• Study optimal intracranial pressure management strategies and cerebral perfusion pressure targets in severe TBI 1, 4
• Examine management of patients with lucid intervals who are at high risk for expanding intracranial lesions 4

Prehospital and Systems Research

• Investigate field triage criteria to reduce undertriage while managing overtriage costs, as modest shifts in overtriage could have $568 million cost implications 1
• Study advanced automatic collision notification technology integration into trauma systems 1
• Examine noninvasive monitoring technologies including heart rate variability, respiratory rate, and tissue oxygenation for field triage 1
• Research optimal transport destinations and the impact of direct transport to Level I trauma centers on mortality 3, 5

Patient-Centered Outcomes Research

• Develop and validate patient-centered outcome measures beyond simple mortality or amputation rates, as these have limited applicability for demonstrating intervention effectiveness 2
• Investigate intermediate and long-term functional outcomes that matter most to trauma patients 2
• Study quality of life measures specific to trauma populations across the recovery continuum 2
• Examine end-of-life decision-making and patient preferences for trauma care in elderly populations 1

Ventilation and Respiratory Management

• Research protective ventilation strategies in bleeding trauma patients at risk for acute lung injury, including optimal tidal volumes and PEEP levels 1, 5
• Investigate the impact of hyperventilation on mortality in severely hypovolemic trauma patients 1, 3
• Study optimal PaCO₂ targets in traumatic brain injury patients without signs of herniation 1, 4

Coagulopathy and Transfusion Medicine

• Examine tranexamic acid administration protocols in traumatic hemorrhage, including optimal timing and dosing 6
• Study massive transfusion protocols and ratios of blood products in trauma resuscitation 5
• Investigate early recognition and reversal of trauma-induced coagulopathy 1, 5

Infection and Sepsis in Trauma

• Research antibiotic stewardship in trauma ICU populations where 54.3% receive antibiotics and 33% have infections 7
• Study immunomodulatory interventions to reduce infection susceptibility in catabolic trauma patients 1
• Investigate optimal prophylactic antibiotic strategies for specific injury patterns 1

Polytrauma and Multiple Organ Dysfunction

• Examine the pathobiochemical and immunopathological sequelae of severe trauma to develop targeted interventions for organ dysfunction 8
• Study the diversity of conditions in trauma ICUs where 46.9% are trauma patients, 37.8% are non-trauma surgical, and 14.4% are medical patients 7
• Investigate management strategies for high-acuity conditions including septic shock (10.2%), multiple organ failure (5.58%), and ARDS (4.38%) 7

Enhanced Recovery After Trauma

• Research implementation of Enhanced Recovery After Surgery (ERAS) principles in acute trauma populations, adapting protocols from elective surgery 9
• Study multimodal interventions to reduce length of stay, complications, and costs in trauma patients 9
• Investigate early mobility protocols and their impact on metabolic demands in trauma patients 1, 9

Critical Research Gaps Requiring Immediate Attention

Time-critical interventions need rigorous evaluation, as every additional minute of prehospital scene time correlates with 1% increased mortality and every minute of response time with 2% increased mortality in penetrating trauma 3

Preventable death analysis shows 34.5% of early hemorrhagic deaths are potentially preventable by stopping bleeding early, highlighting the need for research on rapid hemorrhage control techniques 3

The 60-minute emergency department time limit for hemorrhagic shock patients requires validation across diverse trauma systems 3