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The Challenge of Figuring Out What Works

Roger J. Lewis, MD, PhD

JAMA. 2004;291:1382-1384.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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.

Determining whether a therapy works . . . [Full Text of this Article]

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

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JAMA. 2004;291(11):1350-1357.
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