Danbot: Complete article rewrite

2026-03-21T22:58:44Z

Complete article rewrite

← Older revision		Revision as of 22:58, 21 March 2026
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	~~PMID~~ 7935634		{{JC info
			\| title= Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries
			\| abbreviation= Delayed Resuscitation
			\| expansion=
			\| published= 1994
			\| author= Bickell WH, Wall MJ Jr, Pepe PE, et al.
			\| journal= N Engl J Med
			\| year= 1994
			\| volume= 331
			\| issue= 17
			\| pages= 1105-1109
			\| pmid= 7935634
			\| fulltexturl= https://www.nejm.org/doi/full/10.1056/NEJM199410273311701
			\| pdfurl=
			\| status = Complete
			}}

			==Clinical Question==
			Does delaying aggressive fluid resuscitation until operative intervention improve survival in hypotensive patients with penetrating torso injuries?

			==Conclusion==
			*Delayed fluid resuscitation until operative intervention was associated with improved survival and fewer complications in hypotensive patients with penetrating torso injuries
			*Immediate resuscitation may worsen hemorrhage by increasing blood pressure before surgical control of bleeding

			==Major Points==
			*This was a landmark study that challenged the standard practice of aggressive prehospital and ED fluid resuscitation in trauma
			*Survival was significantly higher in the delayed resuscitation group (70% vs 62%, p=0.04)
			*Delayed resuscitation was associated with shorter hospital stays and fewer complications (ARDS, renal failure, coagulopathy, wound infection)
			*The concept of "permissive hypotension" in trauma resuscitation was largely influenced by this study
			*Results were specific to penetrating torso trauma in an urban setting with short transport times

			==Study Design==
			*Prospective, controlled clinical trial
			*Single center: Ben Taub General Hospital, Houston, Texas
			*N = 598 adult patients with penetrating torso injuries and prehospital SBP <=90 mmHg
			*Study period: 1990-1993
			*Primary Outcome: survival to hospital discharge

			==Population==
			===Patient Demographics===
			*Mean age: 31 years
			*Male: 96%
			*Gunshot wounds: 59%, Stab wounds: 41%
			*Mean prehospital SBP: 72 mmHg (immediate) vs 79 mmHg (delayed)
			===Inclusion Criteria===
			*Age >=16 years
			*Penetrating torso injury
			*Prehospital SBP <=90 mmHg
			===Exclusion Criteria===
			*GCS <=8 (isolated head injury)
			*Transfer from another facility
			*Transport time >30 minutes

			==Interventions==
			*Immediate resuscitation group (n=309): Standard IV fluid resuscitation beginning in the prehospital setting and continuing in the ED
			*Delayed resuscitation group (n=289): IV access obtained but fluids withheld until patient was in the operating room
			*Both groups received standard surgical management

			==Outcomes==
			===Primary Outcome===
			*Survival to hospital discharge:
			**Delayed resuscitation: 203/289 (70%)
			**Immediate resuscitation: 193/309 (62%)
			**p = 0.04
			===Secondary Outcomes===
			*Postoperative complications were lower in the delayed group:
			**ARDS: 2% vs 7%
			**Acute renal failure: 1% vs 4%
			**Coagulopathy: 1% vs 4%
			**Wound infection: 5% vs 11%
			*Shorter hospital stay in delayed group: 11 vs 14 days

			==Criticisms==
			*Not a true randomized trial; allocation was based on alternating days, which may introduce bias
			*Single-center study in an urban trauma center with short transport times; may not apply to rural settings
			*Only included penetrating trauma; results should not be extrapolated to blunt trauma
			*Baseline differences between groups (injury severity, mechanism) may have confounded results
			*The study has never been replicated in a true randomized fashion due to ethical concerns
			*Concept of permissive hypotension has been broadened well beyond the original study population

			==Funding==
			*None reported

			==See Also==
			*[[Trauma resuscitation]]
			*[[Hemorrhagic shock]]
			*[[Damage control resuscitation]]

			==References==
			<references/>

	[[Category:EBQ]]		[[Category:EBQ]]
			[[Category:Trauma]]

Rossdonaldson1 at 22:32, 1 December 2013

2013-12-01T22:32:42Z

← Older revision		Revision as of 22:32, 1 December 2013
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	PMID 7935634		PMID 7935634

			[[Category:EBQ]]

Rossdonaldson1: Rossdonaldson1 moved page Delayed Fluid Resuscitation in Trauma to EBQ:Delayed Fluid Resuscitation in Trauma

2013-12-01T22:32:16Z

Rossdonaldson1 moved page Delayed Fluid Resuscitation in Trauma to EBQ:Delayed Fluid Resuscitation in Trauma

← Older revision	Revision as of 22:32, 1 December 2013
(No difference)

Ostermayer: Created page with "PMID 7935634"

2013-11-13T06:08:51Z

Created page with "PMID 7935634"

New page

PMID 7935634

EBQ:Delayed Fluid Resuscitation in Trauma - Revision history

Danbot: Complete article rewrite

Rossdonaldson1 at 22:32, 1 December 2013

Rossdonaldson1: Rossdonaldson1 moved page Delayed Fluid Resuscitation in Trauma to EBQ:Delayed Fluid Resuscitation in Trauma

Ostermayer: Created page with "PMID 7935634"