Challenges, Advances, and Contemporary Developments in Trauma Care in Emergency Departments: A Scoping Review.

INTRODUCTION: Trauma is a leading cause of death worldwide, with emergency departments playing a pivotal role in the period from injury to emergency stabilization and treatment. Despite advances in trauma care, emergency department trauma management continues to face clinical, operational, and psychosocial challenges. This scoping review synthesizes evidence on challenges, innovations, and outcomes in emergency department-based trauma care, covering prehospital, in-hospital, system-level, and psychosocial aspects. METHODS: We conducted a literature search PubMed, Scopus, and Web of Science (2020-May 2025) using MeSH and free-text terms. Eligible studies included original research and syntheses on emergency department trauma interventions, systems, and outcomes. Twelve studies were ultimately included. RESULTS: Persistent challenges include communication failures during handover, delayed airway or hemorrhage control, trauma-induced coagulopathy, under-triage of elderly or high-risk patients, and clinician burnout. Concurrent innovations include damage-control resuscitation, resuscitative endovascular balloon occlusion of the aorta, viscoelastic testing, hybrid emergency department models, early tranexamic acid administration, and enhanced triage. Trauma-informed and palliative care approaches may enhance patient-centeredness, while artificial intelligence, predictive analytics, and remote monitoring show promise for future applications. Despite these advances, implementation barriers and evidence gaps remain. DISCUSSION: Although emergency department trauma care has improved in efficiency and precision, gaps persist in communication, early stabilization, geriatric care, and provider well-being. Future research should prioritize multicenter trials, long-term functional outcomes, cost-effectiveness, and the equitable implementation of scalable models to strengthen global trauma systems.