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Review Article

Trauma
Hemostatic resuscitation in patients with trauma-induced coagulopathy: a narrative review: Junsik Kwon, Byung Hee Kang; Acute Crit Care. 2026;41(1):47-57. Published online January 20, 2026; DOI: https://doi.org/10.4266/acc.003525

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716 Download
2 Web of Science
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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.

Citations

Citations to this article as recorded by

Management of trauma‐induced coagulopathy in the perioperative setting: What is the role of anesthesia?
Angela M. Mitchell, Brennah C. O'Connell, Valerie G. Sams
Transfusion.2026;[Epub] CrossRef
N-Acetylcysteine Attenuates Oxidative Stress and Preserves Red Blood Cell Quality During Whole Blood Storage
Sonia Eligini, Lisa Brocca, Alice Mallia, Arianna Valeriano, Erica Gianazza, Cristina Banfi
Antioxidants.2026; 15(7): 858. CrossRef

Original Articles

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

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245 Download
21 Web of Science
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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

Trauma
The Best Prediction Model for Trauma Outcomes of the Current Korean Population: a Comparative Study of Three Injury Severity Scoring Systems: Kyoungwon Jung, John Cook-Jong Lee, Rae Woong Park, Dukyong Yoon, Sungjae Jung, Younghwan Kim, Jonghwan Moon, Yo Huh, Junsik Kwon; Korean J Crit Care Med. 2016;31(3):221-228. Published online August 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00486

13,670 View
227 Download
8 Crossref

Abstract PDF

Background
Injury severity scoring systems that quantify and predict trauma outcomes have not been established in Korea. This study was designed to determine the best system for use in the Korean trauma population.
Methods
We collected and analyzed the data from trauma patients admitted to our institution from January 2010 to December 2014. Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS) were calculated based on the data from the enrolled patients. Area under the receiver operating characteristic (ROC) curve (AUC) for the prediction ability of each scoring system was obtained, and a pairwise comparison of ROC curves was performed. Additionally, the cut-off values were estimated to predict mortality, and the corresponding accuracy, positive predictive value, and negative predictive value were obtained.
Results
A total of 7,120 trauma patients (6,668 blunt and 452 penetrating injuries) were enrolled in this study. The AUCs of ISS, RTS, and TRISS were 0.866, 0.894, and 0.942, respectively, and the prediction ability of the TRISS was significantly better than the others (p < 0.001, respectively). The cut-off value of the TRISS was 0.9082, with a sensitivity of 81.9% and specificity of 92.0%; mortality was predicted with an accuracy of 91.2%; its positive predictive value was the highest at 46.8%.
Conclusions
The results of our study were based on the data from one institution and suggest that the TRISS is the best prediction model of trauma outcomes in the current Korean population. Further study is needed with more data from multiple centers in Korea.

Citations

Citations to this article as recorded by

Outcomes in trauma patients undergoing veno-venous extracorporeal membrane oxygenation for acute respiratory distress syndrome
Seon Hee Kim, Up Huh, Seunghwan Song, Min Su Kim, Il Jae Wang, Young Jin Tak
Perfusion.2023; 38(5): 1037. CrossRef
Prehospital Trauma Scoring Systems for Evaluation of Trauma Severity and Prediction of Outcomes
Radojka Jokšić-Mazinjanin, Nikolina Marić, Aleksandar Đuričin, Zoran Gojković, Velibor Vasović, Goran Rakić, Milena Jokšić-Zelić, Siniša Saravolac
Medicina.2023; 59(5): 952. CrossRef
Thorax trauma severity score and trauma injury severity score evaluation as outcome predictors in chest trauma
Tamer F.A. El-Aziz, Abdallah S. El Din Abdallah, Alaa G.A. Abdo, Mohammed A. El-Hag-Aly
Research and Opinion in Anesthesia & Intensive Care.2022; 9(2): 112. CrossRef
Correlation between trauma and injury severity score and prognosis in patients with trauma
Chusnul Chatimah, Indah D. Pratiwi, Chairul H. Al Husna
Journal of Taibah University Medical Sciences.2021; 16(6): 807. CrossRef
Trauma Volume and Performance of a regional Trauma Center in Korea: Initial 5-year analysis
Byungchul Yu, Giljae Lee, Min A Lee, Kangkook Choi, Sungyoul Hyun, Yangbin Jeon, Yong-Cheol Yoon, Jungnam Lee
Journal of Trauma and Injury.2020; 33(1): 31. CrossRef
Inclusion of lactate level measured upon emergency room arrival in trauma outcome prediction models improves mortality prediction: a retrospective, single-center study
Jonghwan Moon, Kyungjin Hwang, Dukyong Yoon, Kyoungwon Jung
Acute and Critical Care.2020; 35(2): 102. CrossRef
Trauma and Injury Severity Score modification for predicting survival of trauma in one regional emergency medical center in Korea: Construction of Trauma and Injury Severity Score coefficient model
In Hye Kang, Kang Hyun Lee, Hyun Youk, Jeong Il Lee, Hee Young Lee, Keum Seok Bae
Hong Kong Journal of Emergency Medicine.2019; 26(4): 225. CrossRef
The thorax trauma severity score and the trauma and injury severity score
Seong Ho Moon, Jong Woo Kim, Joung Hun Byun, Sung Hwan Kim, Jun Young Choi, In Seok Jang, Chung Eun Lee, Jun Ho Yang, Dong Hun Kang, Ki Nyun Kim, Hyun Oh Park
Medicine.2017; 96(42): e8317. CrossRef

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