Agitation on arrival in trauma patients is known as a sign of impending demise. The
aim of this study is to determine outcomes for trauma patients who present in an agitated
state. We hypothesized that agitation in the trauma bay is an early indicator for
hemorrhage in trauma patients.
We performed a single-institution prospective observational study from September 2018
to December 2020 that included any trauma patient who arrived agitated, defined as
a Richmond Agitation-Sedation Scale of +1 to +4. Variables collected included demographics,
mechanism of injury, admission physiology, blood alcohol level, toxicity screen, and
injury severity. The primary outcomes were need for massive transfusion (≥ 10 units)
and need for emergent therapeutic intervention for hemorrhage control (laparotomy,
preperitoneal pelvic packing, sternotomy, thoracotomy, or angioembolization).
Of 4657 trauma admissions, 77 (2%) patients arrived agitated. Agitated patients were
younger (40 versus 46, P = 0.03), predominantly male (94% versus 66%, P < 0.0001) sustained more penetrating trauma (31% versus 12%, P < 0.0001), had a lower systolic blood pressure (127 versus 137, P < 0.0001), and a higher Injury Severity Score (17 versus 9, P < 0.0001). On multivariable logistic regression, agitation was independently associated
with massive transfusion (odds ratio: 2.63 [1.20-5.77], P = 0.02) and emergent therapeutic intervention for hemorrhage control (odds ratio:
2.60 [1.35-5.03], P = 0.005).
Agitation in trauma patients may serve as an early indicator of hemorrhagic shock,
as agitation is independently associated with a two-fold increase in the need for
massive transfusion and emergent therapeutic intervention for hemorrhage control.