"Giving IV fluids to trauma victims found harmful", NY Times, 28, Oct 94, p. A9. Bleeding trauma patients are usually given fluids in order to keep their blood pressure up, but this practice may actually be harmful. "Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries", W. H. Bickell et al., New England Journal of Medicine, 27 Oct 94, v. 331, pp. 1105-1109. Background: Giving IV fluids to trauma patients before their bleeding is controlled may be detrimental. This procedure has been standard for the past two decades because it was proven successful for severe hypotension due to hemorrhage. Objective: The purpose of this study was to determine the effects of delaying fluid resuscitation until the time of operative intervention in hypotensive patients with penetrating injuries to the torso. Kind of study: Non-randomized experiment Subjects: 598 adults with penetration torso injuries with a pre-hospital systolic blood pressure less than or equal to 90 mm Hg. Setting: City with a centralized system (Houston) of pre- hospital emergency care and a single receiving facility for patients with major trauma. Treatments: Immediate-resuscitation group and delayed- resuscitation group. The difference between the two is that the first group received fluid resuscitation before they reached the hospital and the others didn't receive it until they reached the operating room. Treatment assignment: Depended on whether the person was injured on an odd-numbered or even-numbered day. Outcome measurements: Survival of patients Blindness: Patients knew how they were treated, but it probably didn't alter their will to survive. Physicians were not blind. Population: People aged 16 and over with a gunshot or stab wound to the torso and with a blood pressure less than 90 mm Hg. Pregnant women were not enrolled in the study. Patients were also measured for the Revised Trauma Score to see if they were to be included in the study; those with a score of 0 were not included, as well as those with fatal gunshot wounds to the head and patients with minor injuries not requiring operative intervention. Design of study: To pick a sample size, the authors assumed that death would occur in approximately 35% of patients receiving standard preoperative fluid resuscitation for penetrating torso injuries. Based on experimental data and past experience, an estimated 10 to 15 percent improvement in survival was predicted if fluid resuscitation was delayed until the person was operated on. Using a two-tailed alpha value of 0.05 and a beta value of 0.2, it was determined that the sample size should be approximately 600 people. Statistical methods used: A comparison of different characteristics of people in the two treatment groups was performed to see if the randomization of treatments resulted in similar study groups (table 1). Categorical variables were compared with chi-squared tests, and continuous variables were compared with the Mann-Whitney U rank-sum test. Continuous variables were expressed as means +/- the SD. Six tables were also included in this journal article. Stated conclusions: Of the 289 patients who received delayed fluid resuscitation, 203 (70%) survived and were discharged from the hospital. In the other group, 193 out of 309 (62%) patients survived (this difference between the two percentages is statistically significant to P=0.04). Among the 238 patients in the delayed-resuscitation group who survived to to post-operative period, 55 (23%) had one or more complications. Among the 227 patients in the immediate-resuscitation group who survived to the post-operative period, 69 (30%) had complications (the difference is statistically significant to P=0.08). In addition, the duration of hospitalization was shorter in the delayed-resuscitation group. Nonresponse: None. As long as the patients met the initial eligibility requirements, they were part of the study. Difficulties of generalizing to the real world: This study only found the effects of specific types of wounds. Also, those with blood pressures below 40 mm Hg, which rarely survived, weren't included in he study, and so this cohort should also be examined in a different study. Other problems: They could have examined and performed more statistical analysis on the data pertaining to complications. How does this relate to the rest of the scientific literature: These findings are similar to conclusions of studies done on animals.