KSCCM
Search
- Page Path
- HOME > Search
Review Article
- Trauma
- Hemostatic resuscitation in patients with trauma-induced coagulopathy: a narrative review
- Junsik Kwon, Byung Hee Kang
- Received August 21, 2025 Accepted October 20, 2025 Published online January 20, 2026
- DOI: https://doi.org/10.4266/acc.003525 [Epub ahead of print]
- 1,523 View
- 426 Download
-
Abstract
PDF - Hemorrhage remains a leading cause of preventable death in trauma, emphasizing the importance of early bleeding control. In addition to mechanical hemostasis, effective management of trauma-induced coagulopathy (TIC) plays a critical role in improving outcomes. TIC is a multifactorial condition with diverse phenotypes, involving complex pathophysiology. These variations complicate early diagnosis and targeted treatment. In the prehospital setting, phenotype-based management is not feasible; thus, empirical strategies have been adopted. Administration of tranexamic acid and prehospital whole blood transfusion have shown clinical benefit in selected trauma populations. Upon hospital arrival, fixed-ratio massive transfusion protocols and whole blood resuscitation provide broad support for coagulopathic states and have proven effective in reducing early mortality. However, these approaches may not fully account for individual variation in coagulation profiles. Viscoelastic assays allow real-time evaluation of coagulation status and offer the potential for individualized, goal-directed therapy. While some studies suggest improved outcomes with viscoelastic-guided resuscitation, evidence of clear superiority over conventional methods remains limited. Further research is needed to determine the optimal resuscitation strategy and integrate both empirical and precision-based approaches in TIC management.
Original Article
- Trauma
- Factors associated with unplanned intensive care unit readmission among trauma patients in Republic of Korea
- Yongwoong Lee, Byung Hee Kang
- Acute Crit Care. 2024;39(4):583-592. Published online November 22, 2024
- DOI: https://doi.org/10.4266/acc.2024.00584
- 2,982 View
- 161 Download
- 2 Crossref
-
Abstract
PDF
- Background
In trauma patients, unplanned intensive care unit (ICU) readmission (UIR) is associated with poor clinical outcomes. In this study, we aimed to analyze associated factors for UIR in trauma patients.
Methods
This retrospective study was conducted on trauma patients admitted to the ICU at a trauma center from January 2016 to December 2022. Clinical information at admission, the first ICU hospitalization, first discharge from the ICU, and reasons for readmission were collected. Patients who were successfully discharge from the ICU were compared to UIR patients. Logistic regression was performed to determine the factors with a significant impact on ICU readmission.
Results
Here, 5,529 patients were admitted to the ICU over 7 years, and 212 patients (3.8%) experienced UIR. Among patients who experienced UIR, 9 (4.2%) died. In the UIR patients, hospital stay (20 days [interquartile range, 13–35] vs. 45 days [28–67], P<0.001), total ICU stay (5 days [3– 11] vs. 17 days [9–35], P<0.001), and complications during the first ICU hospitalization were significantly higher. The most common reason for UIR was respiratory problem (53.8%). In multivariable analysis, cervical spine operation during the first ICU hospitalization (odds ratio, 6.56; 95% CI, 3.62–11.91; P<0.001), renal replacement therapy (RRT; 3.52, 2.06–5.99, P<0.001), and massive blood transfusion protocol (MTP; 1.74, 1.08–2.81, P=0.023) were most highly related with UIR.
Conclusions
Because UIR patients had poor outcomes, trauma patients who underwent cervical spine operation, RRT, or MTP require monitoring in the general ward, especially for respiratory problems. -
Citations
Citations to this article as recorded by
- Unplanned intensive care unit admissions in trauma patients: A critical appraisal
Amlan Swain, Deb Sanjay Nag, Jayanta Kumar Laik, Seelora Sahu, Mrunalkant Panchal, Shivani Srirala
World Journal of Critical Care Medicine.2025;[Epub] CrossRef - Circulation-first trauma resuscitation and mortality: A 9-year single-center retrospective study
Donghwan Choi, Kyoungwon Jung
Journal of Trauma and Acute Care Surgery.2025;[Epub] CrossRef
- Unplanned intensive care unit admissions in trauma patients: A critical appraisal
Image in Critical Care
- Trauma
- Splenic Liquefaction after Splenic Artery Embolization
- Byung Hee Kang
- Acute Crit Care. 2019;34(1):92-94. Published online November 13, 2018
- DOI: https://doi.org/10.4266/acc.2018.00073
- 7,975 View
- 103 Download
Original Article
- Trauma
- Timing and Associated Factors for Sepsis-3 in Severe Trauma Patients: A 3-Year Single Trauma Center Experience
- Seungwoo Chung, Donghwan Choi, Jayun Cho, Yo Huh, Jonghwan Moon, Junsik Kwon, Kyoungwon Jung, John-Cook Jong Lee, Byung Hee Kang
- Acute Crit Care. 2018;33(3):130-134. Published online August 31, 2018
- DOI: https://doi.org/10.4266/acc.2018.00122
- 11,224 View
- 242 Download
- 21 Web of Science
- 21 Crossref
-
Abstract
PDF
- Background
We hypothesized that the recent change of sepsis definition by sepsis-3 would facilitate the measurement of timing of sepsis for trauma patients presenting with initial systemic inflammatory response syndrome. Moreover, we investigated factors associated with sepsis according to the sepsis-3 definition.
Methods
Trauma patients in a single level I trauma center were retrospectively reviewed from January 2014 to December 2016. Exclusion criteria were younger than 18 years, Injury Severity Score (ISS) <15, length of stay <8 days, transferred from other hospitals, uncertain trauma history, and incomplete medical records. A binary logistic regression test was used to identify the risk factors for sepsis-3.
Results
A total of 3,869 patients were considered and, after a process of exclusion, 422 patients were reviewed. Fifty patients (11.85%) were diagnosed with sepsis. The sepsis group presented with higher mortality (14 [28.0%] vs. 17 [4.6%], P<0.001) and longer intensive care unit stay (23 days [range, 11 to 35 days] vs. 3 days [range, 1 to 9 days], P<0.001). Multivariate analysis demonstrated that, in men, high lactate level and red blood cell transfusion within 24 hours were risk factors for sepsis. The median timing of sepsis-3 was at 8 hospital days and 4 postoperative days. The most common focus was the respiratory system.
Conclusions
Sepsis defined by sepsis-3 remains a critical issue in severe trauma patients. Male patients with higher ISS, lactate level, and red blood cell transfusion should be cared for with caution. Reassessment of sepsis should be considered at day 8 of hospital stay or day 4 postoperatively. -
Citations
Citations to this article as recorded by- Lessons Learned From Large Animal Models of Trauma-Induced AKI
David M. Burmeister, Julia N. Nguyen, Ian J. Stewart
Seminars in Nephrology.2026; 46(1): 151670. CrossRef - Sex differences in the time trends of sepsis biomarkers following polytrauma
Cédric Niggli, Philipp Vetter, Jan Hambrecht, Hans-Christoph Pape, Ladislav Mica
Scientific Reports.2025;[Epub] CrossRef - Identifying early predictive and diagnostic biomarkers and exploring metabolic pathways for sepsis after trauma based on an untargeted metabolomics approach
Yi Gou, Bo-Hui Lv, Jun-Fei Zhang, Sheng-Ming Li, Xiao-Ping Hei, Jing-Jing Liu, Lei Li, Jian-Zhong Yang, Ke Feng
Scientific Reports.2025;[Epub] CrossRef - Identifying biomarkers distinguishing sepsis after trauma from trauma-induced SIRS based on metabolomics data: a retrospective study
Yi Gou, Jing-jing Liu, Jun-fei Zhang, Wan-peng Yang, Jian-Zhong Yang, Ke Feng
Scientific Reports.2025;[Epub] CrossRef - ASSESSMENT OF EARLY INDICATORS FOR SEPSIS DEVELOPMENT IN MULTIPLE TRAUMA PATIENTS—THE SEPSIS AS TRAUMA OUTCOME PREDICTION (STOP) SCORE
Nils Becker, Jasmin Maria Bülow, Niklas Franz, Ingo Marzi, Florian Gebhard, Akiko Eguchi, Helen Rinderknecht, Borna Relja
Shock.2025; 64(2): 187. CrossRef - Impact of trauma level designation on mortality in trauma patients with sepsis: an observational study across US trauma centers
Ralphe Bou Chebl, Razan Diab, Reem Siblini, Rana Bachir, Mazen El Sayed
Frontiers in Medicine.2025;[Epub] CrossRef - Antecedent traumatic injuries independently predict higher 90-day mortality for patients admitted to the ICU with surgical sepsis
Courtney M. Collins, Anahita Jalilvand, Whitney Kellett, Holly Baselice, Jon Wisler
The American Journal of Surgery.2025; 250: 116618. CrossRef - A biomarker panel of C-reactive protein, procalcitonin and serum amyloid A is a predictor of sepsis in severe trauma patients
Mei Li, Yan-jun Qin, Xin-liang Zhang, Chun-hua Zhang, Rui-juan Ci, Wei Chen, De-zheng Hu, Shi-min Dong
Scientific Reports.2024;[Epub] CrossRef - Identifying biomarkers deciphering sepsis from trauma-induced sterile inflammation and trauma-induced sepsis
Praveen Papareddy, Michael Selle, Nicolas Partouche, Vincent Legros, Benjamin Rieu, Jon Olinder, Cecilia Ryden, Eva Bartakova, Michal Holub, Klaus Jung, Julien Pottecher, Heiko Herwald
Frontiers in Immunology.2024;[Epub] CrossRef - The Road to Sepsis in Geriatric Polytrauma Patients—Can We Forecast Sepsis in Trauma Patients?
Cédric Niggli, Philipp Vetter, Jan Hambrecht, Hans-Christoph Pape, Ladislav Mica
Journal of Clinical Medicine.2024; 13(6): 1570. CrossRef - Defining Posttraumatic Sepsis for Population-Level Research
Katherine Stern, Qian Qiu, Michael Weykamp, Grant O’Keefe, Scott C. Brakenridge
JAMA Network Open.2023; 6(1): e2251445. CrossRef - Strategies for the treatment of femoral fractures in severely injured patients: trends in over two decades from the TraumaRegister DGU®
Felix M. Bläsius, Markus Laubach, Hagen Andruszkow, Philipp Lichte, Hans-Christoph Pape, Rolf Lefering, Klemens Horst, Frank Hildebrand
European Journal of Trauma and Emergency Surgery.2022; 48(3): 1769. CrossRef - Infectious Diseases-Related Emergency Department Visits Among Non-Elderly Adults with Intellectual and Developmental Disabilities in the United States: Results from the National Emergency Department Sample, 2016
Hussaini Zandam, Monika Mitra, Ilhom Akobirshoev, Frank S. Li, Ari Ne'eman
Population Health Management.2022; 25(3): 335. CrossRef - Patient, provider, and system factors that contribute to health care–associated infection and sepsis development in patients after a traumatic injury: An integrative review
Debbie Tan, Taneal Wiseman, Vasiliki Betihavas, Kaye Rolls
Australian Critical Care.2021; 34(3): 269. CrossRef - Accuracy of Procalcitonin Levels for Diagnosis of Culture-Positive Sepsis in Critically Ill Trauma Patients: A Retrospective Analysis
Aisha Bakhtiar, Syed Jawad Haider Kazmi, Muhammad Sohaib Asghar, Muhammad Nadeem Khurshaidi, Salman Mazhar, Noman A Khan, Nisar Ahmed, Farah Yasmin, Rabail Yaseen, Maira Hassan
Cureus.2021;[Epub] CrossRef - An Evaluation of the Effect of Performance Improvement and Patient Safety Program Implemented in a New Regional Trauma Center of Korea
Yo Huh, Junsik Kwon, Jonghwan Moon, Byung Hee Kang, Sora Kim, Jayoung Yoo, Seoyoung Song, Kyoungwon Jung
Journal of Korean Medical Science.2021;[Epub] CrossRef - The impact of infection complications after trauma differs according to trauma severity
Akira Komori, Hiroki Iriyama, Takako Kainoh, Makoto Aoki, Toshio Naito, Toshikazu Abe
Scientific Reports.2021;[Epub] CrossRef - Gene Expression–Based Diagnosis of Infections in Critically Ill Patients—Prospective Validation of the SepsisMetaScore in a Longitudinal Severe Trauma Cohort
Simone Thair, Caspar Mewes, José Hinz, Ingo Bergmann, Benedikt Büttner, Stephan Sehmisch, Konrad Meissner, Michael Quintel, Timothy E. Sweeney, Purvesh Khatri, Ashham Mansur
Critical Care Medicine.2021; 49(8): e751. CrossRef - Immunometabolic signatures predict risk of progression to sepsis in COVID-19
Ana Sofía Herrera-Van Oostdam, Julio E. Castañeda-Delgado, Juan José Oropeza-Valdez, Juan Carlos Borrego, Joel Monárrez-Espino, Jiamin Zheng, Rupasri Mandal, Lun Zhang, Elizabeth Soto-Guzmán, Julio César Fernández-Ruiz, Fátima Ochoa-González, Flor M. Trej
PLOS ONE.2021; 16(8): e0256784. CrossRef - Sepsis in Trauma: A Deadly Complication
Fernanda Mas-Celis, Jimena Olea-López, Javier Alberto Parroquin-Maldonado
Archives of Medical Research.2021; 52(8): 808. CrossRef - New automated analysis to monitor neutrophil function point-of-care in the intensive care unit after trauma
Lillian Hesselink, Roy Spijkerman, Emma de Fraiture, Suzanne Bongers, Karlijn J. P. Van Wessem, Nienke Vrisekoop, Leo Koenderman, Luke P. H. Leenen, Falco Hietbrink
Intensive Care Medicine Experimental.2020;[Epub] CrossRef
- Lessons Learned From Large Animal Models of Trauma-Induced AKI
First
Prev
