Open research questions in Trauma and Emergency Care Studies

What the literature leaves open

• Non-severe adverse events were more frequent (23% of cases), but their clinical impact after transport could not be assessed in this study and warrants further investi- gation.

  Effect of planned in-hospital transfer on physiological indicators, level of consciousness, pain, and restlessness in Iran · 2026 · DOI

• Maintain routine monitoring of blood utilization indices and NABH quality indicators. Strengthen component preparation, storage, and inventory control to reduce discard rate. Improve donor counseling and donor-selection processes to reduce deferral and donor reactions. Continue periodic feedback to clinicians to optimize ordering practices and transfusion requests. Use audit findings for corrective and preventive actions within the quality management system.

  Blood Utilization and NABH Quality Indicators in a Trauma Center: A Retrospective Cross-Sectional Study · 2026 · DOI

• Background: Trauma remains one of the leading causes of death and disability in the USA, yet trauma research continues to suffer from inconsistent data collection standards, hindering data aggregation and interoperability.

  Adopting common data elements for the National Trauma Research Repository through a consensus meeting: the trauma core · 2026 · DOI

• Several limitations of this study should be acknowledged. The retrospective design and reliance on medical records may have introduced bias. A prospective design and a larger sample size would have enabled us to generalize the findings. The low experience level of the transport team, compared to international standards, may have influenced the accuracy of risk stratification and the overall outcomes of the study.

  Comparison of Pre-transfer Risk Assessment Tools Used for Critically Ill Patient Transport: A Retrospective Study · 2026 · DOI

• Screening questionnaires should be validated and refined in future research to enable the proper detection of missed injuries. Lastly, evidence-based solutions to mitigate the burden of missed injuries could be explored through interventional research on strategies such as regular tertiary surveys, trauma team training using simulation, and post- discharge digital health interventions.

  Prevalence and Patterns of Patient-Reported Missed or Delayed Injuries in Polytrauma Patients and Their Association With Health-Related Quality of Life Using the 36-Item Short Form Health Survey · 2026 · DOI

• This study has several limitations. The RTAS sample was predominantly male, which may limit the representation of women’s perspectives on the post-accident adaptation. The small number of spousal caregivers may also reduce the transferability of the findings. Additionally, transcripts were not returned to participants for comment or correction, and participant validation on the findings (member checking) was not undertaken. Recall bias is possible, given that some RTAS were interviewed up to 13 years post-injury. Also, the translation process may have introduced some bias. Both of which could have influenced the findings. The study’s regional focus limits its transferability; however, this does not diminish its significance in providing valuable insights to inform adaptation and recovery strategies for RTAS in the Thai context.

  “I Realized It Wouldn’t Heal”: A Perspective of Road Traffic Accident Survivors and Roles of Spouses and Health Care Team Members in Northeast Thailand · 2026 · DOI

• This study is limited by its retrospective design, modest sample size, and reliance on recorded documentation. Additionally, consultant subspecialty data were not available for all cases, and delays may have been influenced by unmeasured patient or system confounding variables. The study period, spanning September 2023 to January 2024, encompasses autumn and winter months only. Seasonal variation in trauma volume, staffing levels, and theater availability may therefore influence the findings, and results may not be representative of patterns seen during spring and summer months. Replication across a full calendar year and across multiple centers would strengthen the generalizability of these findings. A significant contributor to the delay in ambulatory trauma management is the inclusion of neck of femur fractures on shared trauma operating lists. Although nonambulatory, these cases require surgery within 48 hours in accordance with NICE guidelines and are therefore prioritized [11]. This may reduce theater availability for ambulatory trauma, contributing to delays within the pathway. This represents a potential confounding factor affecting pathway efficiency that is not directly captured within our dataset. Although data distribution was assessed visually prior to analysis, some variables may not have been normally distributed, which represents a limitation of the statistical analysis.

  Analysis of Ambulatory Trauma in a District General Hospital: System Delays and Need for an Evidence-Based Pathway · 2026 · DOI

• This study was retrospective and conducted at a single center, which limited the generalizability of the findings. Additionally, the relatively small sample size was another limitation. Although the nutritional assessment scores used in this study were supported by evidence for their validity, they may not have fully captured all aspects of malnutrition. Detailed data regarding the specific causes of death were not available. Due to the retrospective design and limitations of the hospital information sys- tem, it was not possible to reliably distinguish deaths directly attributable to trauma from those resulting from secondary complications such as sepsis or organ failure. Therefore, mortality was analyzed as all-cause in-hospital mortality. Finally, frailty, a key determinant of outcomes in older trauma, was not assessed, which represents an additional limitation.

  Comparison of nutritional and trauma scores in older trauma patients presenting to the emergency department · 2026 · DOI

• between centers. However, the fundamental elements for trauma management are present regardless of the reception area: dedicated team, equipment, nursing resources, etc. Organizational differences are also observed according to the annual volume of grade A patients, suggesting a possible impact of the patient volume and the trauma teams’ expertise on the organization of severe trauma patients’ admission [23,24]. Despite the benefits associated with establishing trauma systems, 35% of TC1 in France were not integrated into these networks at the time of this study [10,12–15,25,26]. While it may suggest some disorganization in these regions, it is also possible that some hospitals are not part of an administratively structured network (e.g., an association), but have a ‘‘networked’’ functioning based on triage habits or consensual local protocols. In contrast to North American systems, trauma leadership in France is not assigned to surgeons. Instead, the medical specialties of anesthesia-intensive care and emergency medicine are the most involved in the management of severe trauma patients during the early in-hospital phase. All French anesthetists have dual competence in anesthesia and intensive care (the official name of the specialty being "Anesthesia, Intensive Care and Perioperative Medicine"), and are trained 50% in each area during their residency. For grade A and B trauma, at 97.5% and 90.5% respectively, the trauma leader is almost exclusively a physician specialized in anesthesia and intensive care. These results are consistent with French practice, which has historically placed anesthetists-intensivists in charge of intra-hospital severe trauma care in TC1. Given their technical expertise in trauma care (e.g., neuro-resuscitation, hemorrhagic shock management, airway and vascular access) and experience in managing multidisciplinary teams, anesthetists-intensivists are positioned as for managing these complex situations. They are present throughout the critical phase (thus preserving the continuity of care in critical situations), oversee access to emergency operating rooms, and maintain strong collaborative relationships with surgical and interventional radiology if our data are incomplete for grade C patients, they appear to be primarily managed by emergency medicine physicians in TC1, which probably allows immediate availability of technical and human specialized resources for more severely injured patients. Emergency medicine, due to its expertise in pre-hospital and organizational aspects, is an essential link in the care pathway for these patients..

  Organization of French level 1 adult trauma centers: A national survey · 2026 · DOI

• Limitations to our study include that the study was conducted at a single, major academic institution located in an urban setting, which limits the generalizability of the findings. Although the institution serves a socioeconomically and racially diverse adult population and prior TIC studies have sampled predominantly academic medical environments, the experiences of the residents may differ from those in community hospitals, rural programs, or smaller academic centers10,11. Residents were recruited using a convenience sampling approach based on availability and interest in participation. Although multiple recruitment strategies were employed to maximize participation, some degree of selection bias was likely. While the survey response rate of 56% represents most eligible residents, it does not capture the perspectives of all residents. We conducted one focus JGIM Thachapuzha et al.: I. M. Residents’ Perspectives on TIC group, which limits the breadth of perspectives captured; this decision reflected the difficulty of recruiting busy residents despite extensive outreach. Although the group generated substantial thematic and code development, conducting more focus groups would have allowed for a wider range of perspectives and thematic saturation. The study only included categorical IM residents, and the findings may not extend to residents in other specialties or disciplines. We were unable to assess how residents’ intended career paths (e.g., primary care, subspecialty training, hospital medicine) influenced their attitudes toward TIC or their decision to participate, which may have shaped both survey responses and focus group dynamics. We did not collect demographic information about participants. We did not assess how resident well-being, traumatic stress, or burnout may have affected engagement, though some participants alluded to emotional strain during trauma-related encounters. Future research should explore how resident characteristics and well-being intersect with TIC competence and implementation. The authors intentionally focused on residents’ perceptions of the impact of TIC and barriers to delivering this care on the therapeutic relationship and patient care, as these domains remain relatively understudied in the literature. Future studies should explore trainee experiences with these additional components of TIC such as universal precautions, psychological and physical safety practices, inclusive communication strategies, trauma-informed physical examination approaches, and peer support.

  Internal Medicine Residents’ Challenges in Trauma-Informed Care and Impact on Patient Care: A Multiple-Methods Study · 2026 · DOI

• A strong correlation established between CFI score and these variables further validate its reliability as a perfect tool for communication of the maxillofacial morbidity and in making a treatment protocol, although its predictive ability for associated head injuries needs to be studied further.

  Comprehensive facial injury (CFI) score as a predictor of surgical time, length of hospital stay, and head injury? Our experience at level I trauma center · 2022 · DOI

• The high percentage (around 95%) of self-referred trauma patients that are discharged from the ED presumably indicates that they were referred mainly for the exclusion of dangerous conditions, and/or that appropriate care options are lacking in the community setting.

  Hospital emergency departments · 2022 · DOI

• The purpose is to describe the mixed evidence supporting brief interventions in the emergency department, trauma care, and in-patient medical care settings; examine potential moderators of treatment outcome in light of the mixed evidence; and identify methods to move the research and practice of brief interventions beyond their current state.

  The Mixed Evidence for Brief Intervention in Emergency Departments, Trauma Care Centers, and Inpatient Hospital Settings: What Should We Do? · 2010 · DOI

• There exists bi-national potenlinl 10 collect, repon and assess the same health consequences in Mexico Ihat need to be explored by those working on the U.

  TRAUMA REGISTRIES AS A POTENTIAL SOURCE OF BORDER EPIDEMIOLOGY WORK GROUP INDICATOR DATA · 2005

• But because few studies have investigated injury morbidity among ODS/DS veterans, we do not know how the frequency or severity of injuries differs for deployed US veterans.

  Why are people who return from war at increased risk of injury? · 2001 · DOI

• Considering that learning opportunities on the work floor are scarce, continuous course evaluation is crucial to ensure benefits for medical professionals and their patients.

  Evaluation of a redesigned two-day trauma course incorporating blended learning compared with the traditional three-day trauma course: a retrospective non-inferiority study · 2026 · DOI

• Prospective data simultaneously characterising referral patterns, triage acuity at presentation, diagnostic case mix, and inpatient mortality at a national tertiary paediatric emergency unit are lacking from West Africa.

  Referral pathways, ETAT triage acuity, and inpatient outcomes among children presenting to a national tertiary paediatric emergency unit in Ghana: a prospective cohort study · 2026 · DOI

• Immunological consequences of trauma in paediatric patients remains scarcely explored and associations between injury severity and immunosuppression, a decreased functionality of the immune system, have not yet been investigated in this population.

  Immune function in paediatric trauma patients: a prospective explorative cohort study · 2026 · DOI

• Furthermore, the absence of nighttime helipads in the main hub hospitals remains a significant limitation, as it requires indirect transfer solutions that may be less efficient and may expose patients to additional logistical complexity and transfer- related risks.

  First Nighttime Primary Helicopter Emergency Medical Services (HEMS) Mission in Pediatric Severe Traumatic Brain Injury: Establishing a Functional Night Landing Network in a Resource-Limited Setting · 2026 · DOI

• The authors discuss the limited literature on the implementation of trauma-informed care in intellectual disability services, which is primarily drawn from case studies or non-empirical research.

  Applying the principles of trauma-informed care in intellectual disability services · 2022 · DOI

• The impact of employing a designated trauma social worker (DTSW) in the utilization of these consults has not been described.

  A designated trauma social worker improves coordination of patient care by coordinating ancillary consults · 2022 · DOI

• Research/paper limitations: The proposed methodological approach as explained in this paper is a profile based research and it is constructed for and limited to assessment of War trauma and using it for other purposes could give one false data and interpretations.

  ASSESSMENT AND TREATMENT OF WAR TRAUMA · 2018

• Although remarkable efforts have been made to improve patient fall reporting through the utilization of standardized definitions, injury falls reporting has rarely been examined.

  Reliability and Validity of the NDNQI® Injury Falls Measure · 2014 · DOI

Most-cited papers in Trauma and Emergency Care Studies

• Excess Length of Stay, Charges, and Mortality Attributable to Medical Injuries During Hospitalization · JAMA · 2003 · 786 citations
• Trauma Informed Care in Medicine · Family & Community Health · 2015 · 363 citations
• A Synthesis of the Literature on Trauma-Informed Care · Issues in Mental Health Nursing · 2015 · 353 citations
• The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity · Canadian Medical Association Journal · 2008 · 220 citations
• The cost of injury and trauma care in low- and middle-income countries: a review of economic evidence · Health Policy and Planning · 2013 · 133 citations
• Epidemiology of severe trauma among status Aboriginal Canadians: a population-based study · Canadian Medical Association Journal · 2005 · 74 citations
• Trauma informed education in nursing: A call for action · Nurse Education Today · 2021 · 71 citations
• The Mixed Evidence for Brief Intervention in Emergency Departments, Trauma Care Centers, and Inpatient Hospital Settings: What Should We Do? · Alcoholism Clinical and Experimental Research · 2010 · 67 citations
• The influence of a statewide “Stay-at-Home” order on trauma volume and patterns at a level 1 trauma center in the united states · Injury · 2020 · 65 citations
• National Study of the Emergency Physician Workforce, 2020 · Annals of Emergency Medicine · 2020 · 64 citations

Most recent work

• Helicopter EMS Actuarial Model · PubMed · 2026
• Pain Rehabilitation to Optimize Major Orthopaedic Trauma REcovery (PROMOTE) compared with routine care · The Bone & Joint Journal · 2026
• Strengthening Trauma‐Informed Care in Disability Services: Addressing Everyday and Structural Harm · Journal of Policy and Practice in Intellectual Disabilities · 2026
• Internal Medicine Residents’ Challenges in Trauma-Informed Care and Impact on Patient Care: A Multiple-Methods Study · Journal of General Internal Medicine · 2026
• Predictive value of trauma scoring systems for mortality and intensive care outcomes among trauma patients: a study from central Iran · International Journal of Emergency Medicine · 2026
• Organization of French level 1 adult trauma centers: A national survey · Anaesthesia Critical Care & Pain Medicine · 2026
• Derivation and validation of a clinical prediction score for ICU utilization at trauma intake · The American Journal of Emergency Medicine · 2026
• Comparison of nutritional and trauma scores in older trauma patients presenting to the emergency department · BMC Emergency Medicine · 2026
• Assessment of clinical and logistical contribution in a Norwegian helicopter emergency medical service using integrated data: a retrospective observational study · Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 2026
• Artificial Intelligence in Trauma Care: A Systematic Review of Resuscitation, Diagnosis, Risk Prediction, and Management · Journal of Trauma Nursing · 2026

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