ED Agitation, Imaging, and Injury: An Evidence Synthesis for Imaging Access in Agitated Trauma Patients

Background Agitated adult trauma patients are common in Canadian emergency departments. Cooperation and monitoring constraints can delay essential imaging and risk missed injury. Objective To synthesize current guidance and evidence into an educational framework for timely, safe imaging when the trauma exam is unreliable due to agitation. Methods Narrative review using targeted searches of guideline/agency sources and peer-reviewed trials/meta-analyses on agitation control, extended Focused Assessment with Sonography in Trauma (eFAST), and selective versus whole-body computed tomography (CT). Outputs were a conceptual evidence map and a worked case. Results Current research prioritizes parallel resuscitation with early eFAST. Unstable, eFAST-positive patients usually proceed to hemorrhage control rather than CT. For stable or stabilized adults with an unreliable exam, brief, monitored behavioural control creates a one-trip imaging window under continuous SpO₂/NIBP/ECG (± capnography). Teams select an up-front imaging approach: selective CT once cooperation returns and injuries localize, or whole-body CT when multi-region injury is likely or unreliability persists. The scanner-side bundle includes named monitoring responsibility, an airway plan, and dose-optimized protocols. Downstream steps include interventional radiology--supported non-operative strategies for eligible solid-organ injury, a 24-48 hour tertiary trauma survey, and a structured psychiatry handoff to limit re-sedation. Conclusions In agitated adult trauma, a single, monitored trip to obtain the necessary imaging after brief, guideline-aligned behavioural control may improve safety and throughput. For clinicians, the framework clarifies roles. For patients, it may shorten time to definitive imaging and reduce complications. Prospective, multi‑centre evaluation aligned with local policy is needed to measure effects on time‑to‑CT, adverse events, and missed injuries.