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March 17, 2004

Prehospital Care of the Multiply Injured PatientThe Challenge of Figuring Out What Works

Author Affiliations

Author Affiliations: Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center, Torrance.

JAMA. 2004;291(11):1382-1384. doi:10.1001/jama.291.11.1382

In this issue of THE JOURNAL, Cooper and colleagues1 report the results of a well-designed and well-executed randomized trial comparing 2 fluid resuscitation strategies in the initial prehospital treatment of adults with severe traumatic brain injury and posttraumatic hypotension. Although the results show no evidence of improved neurological outcome with the hypertonic saline (HTS)–based resuscitation strategy, the study is noteworthy for several reasons. First, it is one of relatively few examples of double-blind, randomized controlled studies of therapies for critically ill patients conducted in the prehospital setting.2,3 Such studies are critically important to determine what works in that setting. Second, the study illustrates several issues regarding obtaining informed consent for participation in research from acutely incapacitated patients in the prehospital setting. Third, the study results, although negative, may be helpful in guiding choices of fluid resuscitation strategies in future investigations.

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