Answers:  "Giving IV fluids to trauma victims found harmful", 28 Oct 94,
           NY Times, p. A9.

Journal Article:  "Immediate versus delayed fluid resuscitation for
                   hypotensive patients with penetrating torso injuries",
                   W.H. Bickell et al., 27 Oct 94, The New England Journal of
                   Medicine, v. 331. no. 17, pp. 1105-1109.

1a) The two treatments were the immediate-resuscitation group (in which
    intravascular fluid resuscitation was given before surgical intervention
    in both the prehospital and trauma-center settings) and the delayed-
    resuscitation group (in which intravenous fluid resuscitation was
    delayed until operative intervention).  (p.1106-"Methods: Study
    Interventions")
 b) The subjects were patients over 16 years of age who were transported to 
    Ben Taub General Hospital with gunshot or stab wounds to the torso
    and a systolic blood pressure less than or equal to 90 mm Hg.  They also
    did not have a Revised Trauma Score of zero at the scene of the injury,
    a fatal gunshot wound to the head, and/or minor injuries not requiring
    operative intervention.  There were 598 patients.  (p.1105-06-
    "Methods: Study Subjects" and p.1107-"Results: Characteristics of the
    Patients"-2nd pgrh)
 c) Pre-treatment characteristics that were recorded were blood pressure;
    the Revised Trauma Score (calculated from the Glasgow Coma Scale, systolic
    blood pressure, and respiratory rate); times at which emergency
    vehicles were dispatched, arrived at the scene, departed from the scene,
    and arrived at the trauma center; Injury Severity Score.  (p.1106-
    "Methods: Main Measurements and Secondary Outcome Variables")
 d) The main outcome measurements were survival of patients and assessment
    of six defined postoperative complications (wound infection, adult
    respiratory distress syndrome, sepsis syndrome, acute renal failure,
    coagulopathy, and pneumonia).  (p.1106-"Methods: Main Measurements and
    Secondary Outcome Variables")

2)  Patients injured on even-numbered days of the month were assigned to
    the immediate-resuscitation group, while those injured on odd-numbered
    days were enrolled in the delayed-resuscitation group.  The researchers
    did not assign the treatments randomly probably because of the difficulty
    and confusion to choose which protocol/treatment to use on each patient
    where time was a factor and each patient was unique.  (p.1106-"Methods:
    Study Interventions")

3)  The treatment assignment was blind to the subjects because they did not
    know that they were an experiment.  The treatment assignment was not blind
    to the doctors because they have to know what to give in the pre-hospital
    phase.  (p.1106-"Methods: Study Protocol")

4)  The sample size was calculated on the assumption that death would occur
    in 35% of patients receiving standard preoperative fluid resuscitation
    for penetrating torso injuries.  On the basis of experimental data and
    past clinical experience, an estimated 10 to 15% improvement in 
    survival was predicted if fluid resuscitation was delayed until 
    operative intervention.  With a two-tailed alpha value of 0.05 and a
    beta value of 0.2 (meaning that the probability that the true effect is
    significant is 10-15%) for a hypothesis test, the determination is 
    that approximately 600 patients are needed.  (p.1106-"Methods: 
    Statistical Analysis-1st pgrh)

5)  The sample size seems reasonable, but it can improve since the main
    results are close to the cut-off p-value of 0.05 that some error may
    have occurred.  (p.1108-Table 5)

6)  The article title does not seem to be a reasonable claim because it 
    implies that all trauma victims were considered and studied, whereas the 
    the study admits that these results only pertain to those with 
    penetrating torso injuries.  Plus, the article title also implies that
    IV fluids do not work at all, while the results do show some indication
    that the fluids can help (i.e. not all of the immediate-resuscitation
    group died).  (p.1105-"Abstract: Results" and "Abstract: Conclusions")

7)  The numbers may be higher if those who died right away were accounted
    for.  In fact, the percentage for the delayed-resuscitation group could
    be bigger because death and/or complications may be the results of not
    getting any fluids immediately.  (p.1109-Table 6)

8)  The null hypothesis is just a comparison of proportions (193/309 to 
    203/389).  The question is if this difference occurred by chance.  The
    observed difference is 8%.  Finding the SD of the difference 
    [sqrt(((.62*.38)/309)+(.70*.20)/289)) = 0.035] and dividing this from
    8% [.08/.035 = 2.28] give a result that the difference is 2.28 SD's
    away from zero.  The Z-test is performed (two-sided) to give a p-value =
    0.04.  (p.1106-"Methods: Statistical Analysis")

9)  Pregnant women were excluded in the study to make the sample and
    the results representative and general to the whole population.  Plus,
    there are outside complications that occur during pregnancy that 
    might confound the study.  Also moral issues could be involved (risk the
    life of the baby?)  Those in car accidents were excluded because they are
    more likely not to get penetrating wounds or more likely received wounds
    that are not serious enough to get IV fluids.  (p.1105-"Methods: Study 
    Subjects"-1st pgrh)

10) A possible paragraph would be:
        "Despite indications that the delayed-resuscitation group 
         appeared to have fewer complications, there was not enough
         done to study this part of the aspect.  People who died 
         immediately after operative intervention were not included
         in these calculations.  Complications might had come from
         not getting fluids, which could result in death; but these
         patients were not accounted for in this analysis of the
         existence of complications."
    (p.1109-Table 6)