Droperidol for the Management of the Undifferentiated and Agitated Trauma Patient

OBJECTIVE: Droperidol is increasingly used for agitated behaviour in emergency settings, and whilst Acute Behavioural Disturbance (ABD) guidelines exist for the general population, the use in trauma patients is not defined. This study aimed to explore the frequency of droperidol use in undifferentiated trauma patients, document adverse events and alignment to the general ABD guideline. METHODS: A retrospective convenience sample of all adult patients between 1/12/21 and 1/12/23 who met trauma activation criteria and received droperidol either pre-hospital or in the emergency department was analysed. Data including patient characteristics, adverse events and alignment with the state ABD guideline were analysed using descriptive means. RESULTS: Over the three-year study period, 87 patients met inclusion criteria, with most patients being of male sex, middle-aged, and sustaining blunt trauma. Adverse events were common, with 9/87 (10%) having hypoxia (sats < 90%, oxygen applied), hypotension (SBP < 90 mmHg), or extrapyramidal symptoms (dystonia). Adverse events were more common with concurrent alcohol/drug use (78%) or more than one sedative agent (67%). Thirteen patients required multiple sedative agents. Younger patients (< 65 years) were more likely to receive a sedative dose aligned with local and state ABD guidelines (OR 4.5, 95% CI 1.51-13.40). CONCLUSIONS: Droperidol is used in undifferentiated trauma patients with ABD. Adverse events were common, and more frequent in patients who report concurrent alcohol or illicit drug use. Wide variation in dose and use of additional medications for sedation of this diverse group was identified in the study and supports the need for further research to define optimal strategies to avoid potentially preventable adverse events.