Immediate versus delayed fluid resuscitation in patients with trauma

To the Editor: Dr. Bickell and his colleagues (Oct. 27 issue)¹ conclude that among hypotensive patients with penetrating injuries to the torso, “delay of aggressive fluid resuscitation until operative intervention improves the outcome.” However, their data do not support this conclusion. First, the alternate-day selection method used to determine therapy is not a true technique of randomization. Second, the mortality in this study involves two groups of patients — those who died before they reached the operating room, most of whom had irreversible conditions, and those who died after surgery. When these groups were analyzed separately, there were no differences.