Excited delirium syndrome (ExDS): Defining based on a review of the Literature

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

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background: Patients present to police, Emergency Medical Services, and the emergency department with aggressive behavior, altered sensorium, and a host of other signs that may include hyperthermia, "superhuman" strength, diaphoresis, and lack of willingness to yield to overwhelming force. A certain percentage of these individuals will go on to expire from a sudden cardiac arrest and death, despite optimal therapy. Traditionally, the forensic community would often classify these as "Excited Delirium" deaths. Objectives: This article will review selected examples of the literature on this topic to determine if it is definable as a discrete medical entity, has a recognizable history, epidemiology, clinical presentation, pathophysiology, and treatment recommendations. Discussion: Excited delirium syndrome is characterized by delirium, agitation, acidosis, and hyperadrenergic autonomic dysfunction, typically in the setting of acute-on-chronic drug abuse or serious mental illness or a combination of both. Conclusions: Based upon available evidence, it is the consensus of an American College of Emergency Physicians Task Force that Excited Delirium Syndrome is a real syndrome with uncertain, likely multiple, etiologies.

Original languageEnglish
Pages (from-to)897-905
Number of pages9
JournalJournal of Emergency Medicine
Volume43
Issue number5
DOIs
StatePublished - Nov 1 2012

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Delirium
Sudden Cardiac Death
Police
Emergency Medical Services
Advisory Committees
Acidosis
Substance-Related Disorders
Hospital Emergency Service
Consensus
Epidemiology
Fever
History
Therapeutics

Keywords

  • agitated delirium
  • excited delirium
  • in-custody death
  • restraint
  • sudden death
  • TASER

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Vilke, G. M., Debard, M. L., Chan, T. C., Ho, J. D., Dawes, D. M., Hall, C., ... Bozeman, W. P. (2012). Excited delirium syndrome (ExDS): Defining based on a review of the Literature. Journal of Emergency Medicine, 43(5), 897-905. https://doi.org/10.1016/j.jemermed.2011.02.017

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, Michael D.; Costello, Melissa Wysong; Mash, Deborah C; Coffman, Stewart R.; McMullen, Mary Jo; Metzger, Jeffery C.; Roberts, James R.; Sztajnkrcer, Matthew D.; Henderson, Sean O.; Adler, Jason; Czarnecki, Fabrice; Heck, Joseph; Bozeman, William P.

In: Journal of Emergency Medicine, Vol. 43, No. 5, 01.11.2012, p. 897-905.

Research output: Contribution to journalArticle

Vilke, GM, Debard, ML, Chan, TC, Ho, JD, Dawes, DM, Hall, C, Curtis, MD, Costello, MW, Mash, DC, Coffman, SR, McMullen, MJ, Metzger, JC, Roberts, JR, Sztajnkrcer, MD, Henderson, SO, Adler, J, Czarnecki, F, Heck, J & Bozeman, WP 2012, 'Excited delirium syndrome (ExDS): Defining based on a review of the Literature', Journal of Emergency Medicine, vol. 43, no. 5, pp. 897-905. https://doi.org/10.1016/j.jemermed.2011.02.017
Vilke, Gary M. ; Debard, Mark L. ; Chan, Theodore C. ; Ho, Jeffrey D. ; Dawes, Donald M. ; Hall, Christine ; Curtis, Michael D. ; Costello, Melissa Wysong ; Mash, Deborah C ; Coffman, Stewart R. ; McMullen, Mary Jo ; Metzger, Jeffery C. ; Roberts, James R. ; Sztajnkrcer, Matthew D. ; Henderson, Sean O. ; Adler, Jason ; Czarnecki, Fabrice ; Heck, Joseph ; Bozeman, William P. / Excited delirium syndrome (ExDS) : Defining based on a review of the Literature. In: Journal of Emergency Medicine. 2012 ; Vol. 43, No. 5. pp. 897-905.
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