In pursuit of inter-specialty consensus on excited delirium syndrome: a scoping literature review. Forensic Sci Med Pathol 2023 Dec;19(4):573-594
Date
11/10/2022Pubmed ID
36350497DOI
10.1007/s12024-022-00548-4Scopus ID
2-s2.0-85146333267 (requires institutional sign-in at Scopus site) 1 CitationAbstract
Excited delirium syndrome (ExDS) is a controversial and disputed diagnosis involving altered mentation, agitation, and, frequently, substance abuse. Recently, it has become a common pre-hospital diagnosis, serving as justification for use of force, restraint, and/or medication administration. To conduct a scoping review across three databases to describe the most frequently reported diagnostic criteria for ExDS, as well as to explore its use as a diagnosis for deaths of individuals in the custody of law enforcement. In 2021, three literature databases were searched: Ovid Medline, PsycInfo, and Scopus. Studies were included if they were peer-reviewed, English articles describing (1) ExDS symptoms, (2) substance intoxication with at least 2 ExDS symptoms present, or (3) centering on deaths occurring in the custody of law enforcement and attributed to ExDS. Key study data were extracted and the current literature was described qualitatively. Analysis took place between March and December 2021. A total of 97 studies were identified through initial abstract and secondary full-text review, with noted discrepancies in the definition of ExDS itself. After review, differences in ExDS diagnosis among organizations were explored, along with subsequent clinical impact, particularly in the pre-hospital setting. Resulting impact on patients, particularly those of minoritized ethnic and racial groups, was also noted. Prone aggressive restraint, in particular, is noted as an established risk factor for fatalities in ExDS cases. At this time, ExDS should not be utilized as a diagnosis; major medical organizations have an urgent responsibility to convene to formalize consensus-based diagnostic criteria or to propose alternate management guidelines for agitated and altered persons.
Author List
Slocum S, Fiorillo M, Harding E, Owen J, Long R, Dunn T, Martin IAuthors
Ruby J. Long MD Adjunct Assistant Professor in the Emergency Medicine department at Medical College of WisconsinJulie R. Owen MD Assistant Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
ConsensusDelirium
Humans
Law Enforcement
Police
Risk Factors
