Excited Delirium Syndrome (ExDS): Defining Based on a Review of the Literature

Vilke, Gary M.; DeBard, Mark L.; Chan, Theodore C.; Ho, Jeffrey D.; Dawes, Donald M.; Hall, Christine; Curtis, M. David; Costello, Melissa W.; Mash, Deborah C.; Coffman, Stewart R.; McMullen, M.J.; Metzger, Jeffery C.; Roberts, James R.; Sztajnkrcer, Matthew D.; Henderson, Sean O.; Adler, Jason; Czarnecki, Fabrice; Heck, Joseph J.; Bozeman, William P.

doi:10.1016/j.jemermed.2011.02.017

Cited by 125 publications

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References 27 publications

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“…There are issues with the translation of laboratory studies, which are primarily conducted on healthy volunteers, to the community setting where subjects' physiology is often complicated by the presence of alcohol, stimulants or acute psychiatric distress, including the state of extreme psychomotor agitation and altered consciousness known as excited delirium. [17][18][19][20][21] There remains a deficiency in the systematic collection of high-quality data on the relationship between subject positioning and occurrence of sudden in-custody death under real-world conditions. While several case series exist that document outcomes in proned subjects, the true effect of positioning cannot be examined for its role in sudden in-custody death if only prone positioning is evaluated.…”

Section: Of 19mentioning

confidence: 99%

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Hall

Votova

Heyd

et al. 2015

Journal of Forensic and Legal Medicine

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Despite continued cases of sudden in-custody death in subjects who are restrained, little is understood about the incidence of sudden death, its underlying pathophysiology, or its actual relationship to subject positioning. This paper reports data from 4828 consecutive use of force events (August 2006-March 2013 in 7 Canadian police agencies in 4 cities including Eastern and Western Canada. Methods: Human subjects committee approval was obtained in each city with approval for enrolment of subjects without consent. Consecutive subjects aged >18 years who were involved in a police use of force event were included regardless of the cause or outcome. Officers prospectively documented the final resting position of the subject, whether there was knowledge or suspicion that the subject was intoxicated with alcohol and/or drugs, suffering from emotional distress or any combination of those, the number and nature of a standardized list of features of excited delirium present, and the use of all force modalities alone or in combination. Our outcome of interest was sudden, unexpected in-custody death. Confidence intervals for differences were considered significant if the 95% confidence interval for the difference did not include zero. Assuming an alpha error of 5%, a beta error of 20%, a sample size of 1945 subjects per group gives our study 80% power to detect a difference of 0.5% in sudden death between the prone and not prone position. Results: During the study there were over 3.25 million consecutive police-public interactions; use of force occurred in 4,828 subjects (0.1% of police public interactions; 95% CI = 0.1%, 0.1%). 90% of subjects had complete information on positioning; none of the subjects without documentation of positioning died. Subjects were usually male (87.5%); median age 32 years. Subjects were abnormal with 81.5% of subjects documented to have one or more of alcohol and/or drug intoxication, and/or psychiatric/emotional distress at the scene. Significantly more subjects remained in a non-prone vs. prone position; yet over 2000 subjects remained prone. Although 5.3% more subjects with any assessed comorbidity were in the "not-prone" position, over 1500 with any assessed comorbidity were prone. Significantly more individuals with >3 features of excited delirium were not-prone while significantly more subjects with drug intoxication alone were in prone. There was no difference in CEW deployment in any mode between the positions. One individual died suddenly and unexpectedly; the individual was in the not prone position and exhibited all 10 features of excited delirium. No subject died in the prone position. In a worst case scenario our confidence intervals indicate, with a high degree of precision, that 99.8% of subjects would be expected to survive being in either the prone or notprone position following police use of force. Conclusions: Prone positioning is common following police-public interactions. In this study no subject died among thousands who remained in the prone position after po...

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Section: Of 19mentioning

confidence: 99%

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Hall

Votova

Heyd

et al. 2015

Journal of Forensic and Legal Medicine

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“…Other drugs associated with excited delirium include methamphetamine, lysergic acid diethylamide (LSD) and phencyclidine (PCP). New designer drugs, such as the synthetic cathinones and NBOMe compounds, are also constantly appearing that may result in acute delirium [5,6].…”

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“…The term was coined in 1985 by Wetli and Fishbain [7], although it has been applied differently in different areas of medicine since then [8]. The victim is usually an obese male, aged in his thirties, with a history of either acute-on-chronic drug use or psychiatric illness such as schizophrenia or mania [5,[9][10][11].…”

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confidence: 99%

“…Lethal ventricular arrhythmias are not common, with bradycardic and pulseless electrical activity being more usual, perhaps exacerbated by acidosis. The possibility of prolonged QT and Brugada syndromes should also be considered [5]. Rarely alternative mechanisms of death such as blunt craniofacial trauma may be reported [6].…”

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confidence: 99%

“…Concomitant alcohol use has also been documented, but this is not always the case. The mortality rate has been difficult to determine given the lack of pathognomonic features, however it has been suggested that death only occurs in a small percentage of cases (most likely <10%) [5].…”

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Ongoing issues with the diagnosis of excited delirium

Byard

2017

Forensic Sci Med Pathol

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Human Health Risks of Conducted Electrical Weapon Exposure

et al. 2021

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IMPORTANCE Conducted electrical weapons (CEWs) are used broadly as a less-lethal force option for police officers. However, there is no clear picture of the possible health risks in humans on the basis of rigorously assessed scientific evidence from the international peer-reviewed literature. OBJECTIVE To synthesize and systematically evaluate the strength of published evidence for an association between exposure to different models of CEWs and adverse acute as well as chronic conditions. EVIDENCE REVIEW Following a preregistered review protocol, the literature search strategy was based on a search of reviews published between January 1, 2000, and April 24, 2020, of PubMed, MEDLINE, EMBASE, Web of Science, PsycINFO, and Cochrane Library, as well as relevant online databases and bibliographic sources, such as reference sections of recent publications. The identified studies were independently assessed in terms of scope, relevance, methodologic bias, and quality. Peer-reviewed publications of human studies were included, using original data and with a focus on the use of taser CEWs in the context of law enforcement. Eligible studies examined clearly defined health outcomes as dependent variables following exposure to a CEW. The review followed the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. A meta-analysis could not be conducted. FINDINGS Of the 1081 unique records screened, 33 relevant studies were identified, all of them of experimental design and conducted in the US. Eleven studies had a low risk of bias and 22 had a higher bias risk. Studies focused on outcomes such as physiologic stress responses, heart rate, blood pressure, arrhythmias, or cognitive performance. Independently of bias risk, the studies reported few or no acute health problems, apart from the wounds caused by the darts. Furthermore, no longterm outcomes were studied. Most of the studies were performed on healthy, physically fit individuals (eg, police officers) in a controlled setting, with short exposure duration (5 seconds). Half of the studies, mainly those with a higher risk of bias, were at least partly funded by the manufacturer. CONCLUSIONS AND RELEVANCE Based on the findings of the reviewed studies, the risk for adverse health outcomes due to CEW exposure can be currently estimated as low. However, most of the reviewed studies had methodologic limitations. Considering that recruited participants were not representative of the population that usually encounters a CEW deployment, it is not possible to draw conclusions regarding exposure outcomes in potentially vulnerable populations or high-risk groups, such as those under the influence of substances.

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Excited Delirium Syndrome (ExDS): Defining Based on a Review of the Literature

Cited by 125 publications

References 27 publications

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Restraint in police use of force events: Examining sudden in custody death for prone and not-prone positions

Ongoing issues with the diagnosis of excited delirium

Human Health Risks of Conducted Electrical Weapon Exposure

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