What are some direct and actionable research topics in Trauma Surgery and Critical Care?

Research Topics in Trauma Surgery and Critical Care

High-Priority Research Areas with Direct Clinical Impact

Hemorrhage Control and Resuscitation Strategies

The optimal timing, composition, and ratios of blood product resuscitation in hemorrhagic shock remain incompletely defined and represent critical research opportunities. 1, 2

• Plasma-based resuscitation protocols: Investigate optimal plasma:RBC:platelet ratios beyond the current 1:1:1 paradigm, including prehospital administration of thawed or liquid plasma and its impact on mortality, inflammatory complications, and blood product utilization 1

• Precision coagulation management: Evaluate whether individualized, point-of-care coagulation testing (such as thromboelastography-guided approaches) is superior to empirical massive transfusion protocols for reducing mortality and morbidity 2

• Fibrinogen supplementation timing: Determine the optimal timing and dosing of fibrinogen concentrate versus cryoprecipitate in trauma-induced coagulopathy 2

• Antifibrinolytic therapy optimization: Investigate which subgroups of trauma patients benefit most from tranexamic acid, including optimal timing windows beyond the current 3-hour recommendation 2

• Novel blood products: Evaluate lyophilized blood products, whole blood variants, and novel red cell storage modalities for prehospital and early hospital resuscitation 2

Damage Control Surgery and Critical Care

The specific physiological triggers for transitioning from damage control to definitive surgery require rigorous investigation. 3

• Damage control endpoints: Define objective, measurable physiological parameters (beyond subjective clinical judgment) that indicate readiness for definitive surgical repair after initial damage control 3

• Abbreviated laparotomy techniques: Compare outcomes of different damage control surgical techniques, including optimal packing strategies and temporary abdominal closure methods 3

• Damage control orthopedics: Investigate which "borderline" patients benefit from staged orthopedic fixation versus early definitive fixation, including development of validated risk stratification tools 3

Hemostatic Adjuncts and Technologies

Emerging topical hemostatic agents and mechanical hemorrhage control devices need comparative effectiveness research. 3

• Topical hemostatic agent comparison: Conduct head-to-head trials comparing collagen-based, gelatin-based, and polysaccharide-based hemostatic agents for specific injury patterns (hepatic, splenic, vascular) 3

• Tourniquet safety and efficacy: Determine optimal tourniquet duration, safe release criteria, and long-term limb outcomes in civilian versus military trauma settings 3

• Novel hemorrhage control technologies: Evaluate emerging technologies such as injectable hemostatic foams, resuscitative endovascular balloon occlusion of the aorta (REBOA), and other mechanical adjuncts 3

Geriatric and Frail Trauma Patients

Undertriage and suboptimal management of elderly trauma patients represent a major mortality gap requiring targeted research. 3

• Frailty assessment tools: Validate rapid, objective frailty screening instruments for emergency department triage that predict outcomes better than age alone 3

• Age-adjusted resuscitation protocols: Investigate whether elderly patients require different blood pressure targets, transfusion thresholds, and resuscitation endpoints compared to younger patients 3

• Geriatric-specific complications: Study prevention strategies for delirium, pressure injuries, and functional decline in elderly trauma patients admitted to ICU 3

• Anticoagulation reversal: Compare outcomes of different reversal strategies for novel oral anticoagulants (NOACs) in elderly trauma patients with intracranial hemorrhage 3

Nutritional Optimization in Trauma Critical Care

Protein delivery targets and timing in critically ill trauma patients remain controversial despite known associations with mortality. 3

• Protein dosing trials: Conduct adequately powered RCTs comparing protein doses of 1.2-2.0 g/kg/d versus higher doses in mechanically ventilated trauma patients, given conflicting evidence from the EFFORT trial 3

• Early versus delayed enteral nutrition: Determine optimal timing for initiating enteral nutrition in trauma patients with abdominal injuries or damage control surgery 3

• Immunonutrition in trauma: Evaluate omega-3 fatty acids, arginine, and glutamine supplementation for reducing infectious complications and improving wound healing 3

Traumatic Brain Injury Management

Neuroprotective strategies and outcome prediction in TBI require identification of patient subgroups most likely to benefit. 3, 2

• Therapeutic hypothermia patient selection: Identify which TBI severity subgroups benefit from therapeutic hypothermia, including optimal timing, duration, cooling method, and rewarming rate 3, 2

• Decompressive craniectomy timing: Determine which patients benefit from early versus delayed decompressive craniectomy based on objective criteria 2

• Novel biomarkers: Validate blood-based biomarkers for predicting long-term neurological outcomes and chronic symptoms after mild and severe TBI 2

• Early MRI protocols: Evaluate whether early MRI improves outcome prediction and guides therapeutic decisions in both mild and severe TBI 2

Prehospital Care and Triage

Field triage accuracy, particularly undertriage of high-risk populations, requires system-level research. 3

• Advanced automatic collision notification: Integrate and validate telematics data for improving motor vehicle crash triage accuracy 3

• Noninvasive monitoring technologies: Evaluate heart rate variability, respiratory rate monitoring, tissue oxygenation, and point-of-care lactate testing for prehospital triage 3

• Elderly undertriage prevention: Investigate why older adults are systematically undertriaged and develop age-adjusted triage criteria 3

• Prehospital blood products: Compare outcomes of prehospital plasma and RBC transfusion versus standard crystalloid resuscitation in different injury patterns 1, 4

Spinal Injury Management

Recognition and immobilization techniques for spinal injury by first responders lack high-quality evidence. 3

• Spinal immobilization necessity: Determine which trauma patients truly require spinal immobilization versus selective immobilization based on validated clinical criteria 3

• Immobilization device comparison: Compare outcomes of different spinal stabilization devices and techniques in the prehospital setting 3

Rehabilitation and Long-Term Outcomes

Optimal timing and intensity of rehabilitation after major trauma remain undefined. 2

• Early mobilization protocols: Investigate safety and efficacy of early mobilization in trauma ICU patients, including those with multiple injuries and ongoing critical illness 2

• Multidimensional rehabilitation timing: Determine when to initiate physical, occupational, and cognitive rehabilitation for different injury patterns 2

• Quality of life outcomes: Develop and validate trauma-specific quality of life instruments that capture long-term functional outcomes beyond mortality 2

Common Pitfalls in Trauma Research Design

• Avoid heterogeneous outcome measures: Use standardized outcomes such as mortality, trauma center resource utilization (blood products, interventional radiology, major surgery within 24 hours, ICU admission), and validated quality of life instruments 3

• Control for injury severity: Always adjust for Injury Severity Score (ISS) or Abbreviated Injury Scale (AIS) when comparing interventions 3

• Consider time-to-intervention: Account for time from injury to intervention as a critical confounder in trauma research 3, 5

• Link prehospital to hospital data: Utilize linked databases across care phases rather than isolated prehospital or hospital-only datasets 3