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The role of restraint in fatal excited delirium: a research synthesis and pooled analysis

The purpose of the present study was to perform a comprehensive scientific literature review and pooled data risk factor analysis of excited delirium syndrome (ExDS) and agitated delirium (AgDS). All cases of ExDS or AgDS described individually in the literature published before April 23, 2020 were...

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Autores principales: Strömmer, Ellen M. F., Leith, Wendy, Zeegers, Maurice P., Freeman, Michael D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669776/
https://www.ncbi.nlm.nih.gov/pubmed/32827300
http://dx.doi.org/10.1007/s12024-020-00291-8
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author Strömmer, Ellen M. F.
Leith, Wendy
Zeegers, Maurice P.
Freeman, Michael D.
author_facet Strömmer, Ellen M. F.
Leith, Wendy
Zeegers, Maurice P.
Freeman, Michael D.
author_sort Strömmer, Ellen M. F.
collection PubMed
description The purpose of the present study was to perform a comprehensive scientific literature review and pooled data risk factor analysis of excited delirium syndrome (ExDS) and agitated delirium (AgDS). All cases of ExDS or AgDS described individually in the literature published before April 23, 2020 were used to create a database of cases, including demographics, use of force, drug intoxication, mental illness, and survival outcome. Odds ratios were used to quantify the association between death and diagnosis (ExDS vs. AgDS) across the covariates. There were 61 articles describing 168 cases of ExDS or AgDS, of which 104 (62%) were fatal. ExDS was diagnosed in 120 (71%) cases, and AgDS in 48 (29%). Fatalities were more likely to be diagnosed as ExDS (OR: 9.9, p < 0.0001). Aggressive restraint (i.e. manhandling, handcuffs, and hobble ties) was more common in ExDS (ORs: 4.7, 14, 29.2, respectively, p < 0.0001) and fatal cases (ORs: 7.4, 10.7, 50, respectively, p < 0.0001). Sedation was more common in AgDS and survived cases (OR:11, 25, respectively, p < 0.0001). The results of the study indicate that a diagnosis of ExDS is far more likely to be associated with both aggressive restraint and death, in comparison with AgDS. There is no evidence to support ExDS as a cause of death in the absence of restraint. These findings are at odds with previously published theories indicating that ExDS-related death is due to an occult pathophysiologic process. When death has occurred in an aggressively restrained individual who fits the profile of either ExDS or AgDS, restraint-related asphyxia must be considered a likely cause of the death.
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spelling pubmed-76697762020-11-17 The role of restraint in fatal excited delirium: a research synthesis and pooled analysis Strömmer, Ellen M. F. Leith, Wendy Zeegers, Maurice P. Freeman, Michael D. Forensic Sci Med Pathol Review The purpose of the present study was to perform a comprehensive scientific literature review and pooled data risk factor analysis of excited delirium syndrome (ExDS) and agitated delirium (AgDS). All cases of ExDS or AgDS described individually in the literature published before April 23, 2020 were used to create a database of cases, including demographics, use of force, drug intoxication, mental illness, and survival outcome. Odds ratios were used to quantify the association between death and diagnosis (ExDS vs. AgDS) across the covariates. There were 61 articles describing 168 cases of ExDS or AgDS, of which 104 (62%) were fatal. ExDS was diagnosed in 120 (71%) cases, and AgDS in 48 (29%). Fatalities were more likely to be diagnosed as ExDS (OR: 9.9, p < 0.0001). Aggressive restraint (i.e. manhandling, handcuffs, and hobble ties) was more common in ExDS (ORs: 4.7, 14, 29.2, respectively, p < 0.0001) and fatal cases (ORs: 7.4, 10.7, 50, respectively, p < 0.0001). Sedation was more common in AgDS and survived cases (OR:11, 25, respectively, p < 0.0001). The results of the study indicate that a diagnosis of ExDS is far more likely to be associated with both aggressive restraint and death, in comparison with AgDS. There is no evidence to support ExDS as a cause of death in the absence of restraint. These findings are at odds with previously published theories indicating that ExDS-related death is due to an occult pathophysiologic process. When death has occurred in an aggressively restrained individual who fits the profile of either ExDS or AgDS, restraint-related asphyxia must be considered a likely cause of the death. Springer US 2020-08-22 2020 /pmc/articles/PMC7669776/ /pubmed/32827300 http://dx.doi.org/10.1007/s12024-020-00291-8 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Review
Strömmer, Ellen M. F.
Leith, Wendy
Zeegers, Maurice P.
Freeman, Michael D.
The role of restraint in fatal excited delirium: a research synthesis and pooled analysis
title The role of restraint in fatal excited delirium: a research synthesis and pooled analysis
title_full The role of restraint in fatal excited delirium: a research synthesis and pooled analysis
title_fullStr The role of restraint in fatal excited delirium: a research synthesis and pooled analysis
title_full_unstemmed The role of restraint in fatal excited delirium: a research synthesis and pooled analysis
title_short The role of restraint in fatal excited delirium: a research synthesis and pooled analysis
title_sort role of restraint in fatal excited delirium: a research synthesis and pooled analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7669776/
https://www.ncbi.nlm.nih.gov/pubmed/32827300
http://dx.doi.org/10.1007/s12024-020-00291-8
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