LESSON: Statistical Literacy - IV Treatment for Trauma Victims

Statistical Literacy - Newspaper Article

To begin this lesson, you need to read the article IV Fluids Found Harmful in Trauma Cases which was published in the New York Times on October 28th, 1994.

After you have finished reading this article you can move to the next page of this lesson book..

Statistical Literacy - Medical Journal Experiment

You should have just finished reading the New York Times article about an experiment done by a hospital in Houston where certain patients were delayed in receiving IV therapy after trauma. 

The newspaper article reported on the experiment, now it's time to read the actual study. Found below is an excerpt of the study. Because there is a bunch of medical jargon you may not be familiar with, here are a few definitions you should be familiar with:

Read the excerpt from this article, found below.

Immediate Versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries 

By W.H. Bicknell 

Published in the New England Journal of Medicine 331, p. 1105-1109

For the past two decades the preoperative approach to hypotensive patients with trauma in North America has included prompt intravenous infusion of isotonic fluids. The rationale for this treatment has been to sustain tissue perfusion and vital organ function while diagnostic and therapeutic procedures are performed. This approach was based largely on the demonstration in animals in the 1950s and 1960s that isotonic-fluid resuscitation was an important life-sparing component of therapy for severe hypotension due to hemorrhage.

Patients eligible for this study were adults or adolescents (age at least 16 years) with gunshot or stab wounds to the torso who had a systolic blood pressure less than or equal to 90 mm Hg, including patients with no measurable blood pressure, at the time of the initial on-scene assessment by paramedics from the City of Houston Emergency Medical Services system. Pregnant women were not enrolled in the study. All patients within the city limits of Houston who met the entry criteria were transported directly by ground ambulance to the city's only receiving facility for patients with major trauma, Ben Taub General Hospital.

Patients included in the final study analysis were those in whom fluid resuscitation might affect outcome. Part of the prospective study design was to exclude the following from the outcome analysis: patients with a Revised Trauma Score of zero at the scene of the injury, those who also had a fatal gunshot wound to the head, and patients with minor injuries not requiring operative intervention. The paramedics caring for the patients were not aware of these exclusion criteria and treated all hypotensive patients with penetrating torso injuries according to the protocol.

All patients enrolled in the study were assigned to one of two groups: the immediate-resuscitation group, in which intravascular fluid resuscitation was given before surgical intervention in both the prehospital and trauma-center settings, or the delayed-resuscitation group, in which intravenous fluid resuscitation was delayed until operative intervention. 

Patients injured on even-numbered days of the month were enrolled in the immediate-resuscitation group, whereas those injured on odd-numbered days were enrolled in the delayed-resuscitation group. The alternating 24-hour periods corresponded to the 24-hour shifts worked by both the paramedics and the trauma teams. Because there were three rotating teams of paramedics and surgical house staff, assignments to the groups were alternated automatically for both prehospital and hospital staff members.

Among the 289 patients who received delayed fluid resuscitation, 207 (70%) survived and were discharged from the hospital, as compared with 193 of the 309 patients (62%) who received immediate fluid resuscitation. The mean estimated intra-operative blood loss was similar in the two groups. Among the 238 patients in the delayed resuscitation group who survived to the postoperative period, 55 (23%) had one or more complications (adult respiratory distress syndrome, sepsis syndrome, acute renal failure, wound infection, and pneumonia), as compared with 69 of the 227 patients (30%) in the immediate resuscitation group. The duration of hospitalization was shorter in the delayed-resuscitation group.

Assignment Directions

Now that you've finished reading the information about this experiment, it's time to think about and analyze the information that was presented to you. 

As a statistical student, you need to be able to be able to communicate your thoughts intelligently and accurately. For that reason, this assignment is not meant to be finished in a short period of time. Take your time to construct well-thought out responses. 

You can now begin your assignment found next in the task.