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Open research questions in Trauma, Hemostasis, Coagulopathy, Resuscitation

269 gap statements mined from Trauma, Hemostasis, Coagulopathy, Resuscitation papers in our 7.9M-paper local library, which holds 1,152 papers on the topic — drawn mostly from each paper's own stated research gap, future-work, challenge and limitation notes, and its abstract. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one.

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What the literature leaves open

  • The Quantra device, based on sonorheometry analysis, offers a rapid bedside assessment of coagulation but lacks validation in a trauma population.

    Sonorheometry to detect traumatic induced coagulopathy during initial management of trauma patients: an observational, multi-center study · 2026 · DOI

  • The differential effects of specific colloids on plasmatic coagulation, platelet function and complement activation, especially when used alongside crystalloids, are still underexplored.

    Gelatin 4% and hydroxyethyl starch (130/0.42) impair clot formation in a human ex vivo whole-blood resuscitation model · 2026 · DOI

  • While supported by a randomized trial and America College of Surgeon Trauma Quality Improvement Program(TQIP) guidelines, the inflection point in transfusion volumes at which balanced ratios (1:1) begin to affect mortality has not been fully explored.

    When does 1:1 resuscitation really matter? An analysis of 4,858 patients from four traumatic hemorrhage studies · 2026 · DOI

  • While promising for trauma populations, external validation in various clinical settings is warranted.

    Trauma-specific revision of the Japanese Association for Acute Medicine disseminated intravascular coagulation criteria improves outcome prediction in severely injured patients · 2026 · DOI

  • Although developed for sepsis and other critical illnesses, the conventional Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) score's applicability to trauma populations remains controversial.

    Trauma-specific revision of the Japanese Association for Acute Medicine disseminated intravascular coagulation criteria improves outcome prediction in severely injured patients · 2026 · DOI

  • However, the mechanisms underlying iCa²⁺ changes during trauma and resuscitation remain poorly understood.

    Kinetics and dynamics of ionized calcium in a porcine major trauma model · 2026 · DOI

  • The relationship between type of blood product transfused and incidence of organ dysfunction is not well elucidated.

    Whole blood resuscitation is associated with decreased end-organ dysfunction in pediatric trauma patients · 2026 · DOI

  • Both agents have shown benefit individually, but their combined effect has not been previously investigated in trauma.

    Combined N-acetylcysteine and tranexamic acid attenuate acidosis and fibrinolysis in a swine polytrauma model · 2026 · DOI

  • Wider availability of WB and increasing inventory of platelets and plasma products should be explored to improve battlefield resuscitation.

    Executing balanced resuscitation in bleeding combat casualties: Good versus good enough? · 2026 · DOI

  • Limited data exist on the role of sex in coagulation among geriatric trauma patients.

    Geriatric trauma coagulation profiles: Impact of sex on clot formation · 2026 · DOI

  • Nevertheless, effects of partial- versus total-REBOA inflation on both macrocirculatory and microcirculatory splanchnic flows are not fully understood.

    Effects of partial versus complete aortic occlusion on macro and microcirculatory flows in swine hemorrhagic shock · 2026 · DOI

  • Some microvesicles have been shown to be procoagulant; however, the influence of microvesicles on coagulability of stored whole blood has not been elucidated.

    Microvesicles in stored human whole blood increase thrombin generation via phosphatidylserine · 2026 · DOI

  • Whole blood (WB) transfusion is increasingly used for trauma patients with hemorrhagic shock; however, sex-based differences in utilization and outcomes remain incompletely understood.

    Sex differences in outcomes following whole blood transfusion for patients with severe hemorrhage · 2026 · DOI

  • The results of several randomized controlled trials (RCTs) related to the association between tranexamic acid (TXA) and thrombotic/thromboembolic events have demonstrated conflicting results.

    Thrombotic and thromboembolic events were not associated with tranexamic acid in three large randomized controlled trials · 2026 · DOI

  • The optimal fresh frozen plasma (FFP)-to-red blood cell (RBC) ratio in pediatric severe trauma has not yet been established.

    Association between the fresh frozen plasma-to-red blood cell ratio and mortality in pediatric severe trauma · 2026 · DOI

  • However, prolonged pulmonary ischemia has not been characterized in the setting of hemorrhagic shock.

    Trauma, hemorrhage, and the pulmonary hilum: Defining prolonged pulmonary hilar control in a swine model · 2026 · DOI

  • While prehospital tranexamic acid (TXA) administration has demonstrated survival benefits, the interaction between TXA administration and distinct fibrinolytic profiles remains poorly defined.

    Survival benefit of prehospital TXA in fibrinolytic shutdown: Insights from two prospective trauma trials · 2026 · DOI

  • Viscoelastic testing using thromboelastography (TEG) has been increasingly implemented in trauma resuscitation; however, its prognostic value compared with conventional coagulation testing remains uncertain.

    Prognostic Value of Thromboelastography Parameters for Early Trauma‐Induced Coagulopathy in Severely Injured Patients: A Retrospective Cohort Study · 2026 · DOI

  • The standalone performance of early VHA testing in the ED setting was insufficient to reliably for predict a need for massive transfusion.

    Utility of point of care viscoelastic haemostatic assays for trauma patients in the emergency department · 2025 · DOI

  • Several clinical prediction tools-including the Assessment of Blood Consumption (ABC) score, Trauma-Associated Severe Hemorrhage (TASH) score, and shock index (SI)-have been developed to guide transfusion decisions, but their performance across clinically meaningful outcomes remains uncertain.

    A comparison of clinical prediction scores for massive traumatic hemorrhage · 2025 · DOI

  • Nevertheless, distinctive parameters for predicting the need for transfusion in children are still lacking.

    Indicators of early transfusion in paediatric trauma: a retrospective analysis of 11,849 cases from the TraumaRegister DGU® · 2025 · DOI

  • Current guidelines are based on studies mostly involving fluid-not blood-resuscitation, and acknowledge that existing evidence is limited.

    Blood transfusion – moving from what to how · 2025 · DOI

  • Blood products play an important role in the treatment of massive hemorrhage but may pose a potential risk to the patient when the indication is inconclusive such as in a prehospital setting.

    Pre-hospital assessment of trauma associated severe hemorrhage (phTASH) – analysis of TraumaRegister DGU® data from 2015-2021 · 2025 · DOI

  • Die Optimierung der Antikoagulation bei urologischen Eingriffen ist erforderlich. Die Evaluation von individuellen Risiken ist notwendig. Die Interaktion zwischen DOAK und TAH ist komplex.

    Antikoagulation und Thrombozytenaggregationshemmung in der Urologie · 2026 · DOI

  • Clinicians’ opinions on the definition, measurement, and treatment of ionised hypocalcaemia varied widely.

    Prehospital measurement and treatment of ionised hypocalcaemia by UK helicopter emergency medical services in trauma patients: a survey of current practice · 2025 · DOI

Most-cited papers in Trauma, Hemostasis, Coagulopathy, Resuscitation

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Open questions raised by papers listed on this page include: (1) While promising for trauma populations, external validation in various clinical settings is warranted (“Trauma-specific revision of the Japanese Association for Acute Medicine…”, 2026); (2) The mechanisms underlying iCa²⁺ changes during trauma and resuscitation remain poorly understood (“Kinetics and dynamics of ionized calcium in a porcine major trauma model”, 2026); (3) The relationship between type of blood product transfused and incidence of organ dysfunction is not well elucidated (“Whole blood resuscitation is associated with decreased end-organ dysfunction in…”, 2026); (4) Effects of partial- versus total-REBOA inflation on both macrocirculatory and microcirculatory splanchnic flows are not fully understood (“Effects of partial versus complete aortic occlusion on macro and…”, 2026); (5) Some microvesicles have been shown to be procoagulant; however, the influence of microvesicles on coagulability of stored whole blood has not been elucidated (“Microvesicles in stored human whole blood increase thrombin generation via…”, 2026). 269 gap statements have been mined from Trauma, Hemostasis, Coagulopathy, Resuscitation papers in our 7.9M-paper local library, which holds 1,152 papers on the topic; the gaps come from whichever of those papers state one. They are mostly the research gaps the authors state and the papers' abstracts, plus future-work, limitations and challenges passages. The ones listed below are a selection still marked open; each names the study that raised it, with a DOI link where the paper has one, so you can read the original claim in context.

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