Downloaded from http://emj.bmj.com/ on June 20, 2015 - Published by group.bmj.com
PostScript professional organisations, including the American Medical Association, not acknowledging it as a diagnosis. Until more data are available and a physiologic explanation found, caution should be exercised when considering EXDS as a ‘cause of death.’ Jared Strote Correspondence to Dr Jared Strote, Department of Medicine, University of Washington, 1959 NE Pacific St Seattle WA 98195, Seattle, Washington 98122, USA; [email protected] Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed. To cite Strote J. Emerg Med J 2014;31:256.
Excited delirium as a potentially dangerous diagnosis To the Editor: I read with great interest Dr Huesgen’s BET on Excited Delirium (EXDS) and Sudden Death.1 Dr Huesgen summarises the complex literature well, but an important caveat debated in the literature is missing from the review. As any urban law enforcement officer or emergency physician will attest and as recent research affirms,2 the symptoms present in EXDS are seen with great frequency. The rare diagnosis can only be made retrospectively after those common symptoms are present in conjunction with unexplained death. Lacking a physiologic explanation, the use of the EXDS diagnosis risks tautology: EXDS (agitation with risk of sudden death) was present because death occurred after agitation. The implications of this are significant: if law enforcement use of force is limited by fear of harming all patients who have these symptoms, they may put themselves unnecessarily at risk. And if all agitated patients who die unexpectedly during restraint can be easily dismissed as suffering from EXDS, excessive use of force may be overlooked or excused.3 Our understanding of EXDS is severely limited by its rarity, the difficulty of gathering data in the field where most events occur and the political implications of its use. This has led to numerous medical
256
Accepted 13 November 2013 Published Online First 18 December 2013 Emerg Med J 2014;31:256. doi:10.1136/emermed-2013-203396
REFERENCES 1 2
3
Karl Huesgen. BET 1: excited delirium syndrome and sudden death. Emerg Med J 2013;30:958–60. Hall CA, Kader AS, Danielle McHale AM, et al. Frequency of signs of excited delirium syndrome in subjects undergoing police use of force: descriptive evaluation of a prospective, consecutive cohort. J Forensic Leg Med 2013;20:102–7. Ranson D. Excited delirium syndrome: a political diagnosis? J Law Med 2012;19:667–72.
Emerg Med J March 2014 Vol 31 No 3
Downloaded from http://emj.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Excited delirium as a potentially dangerous diagnosis Jared Strote Emerg Med J 2014 31: 256 originally published online December 18, 2013
doi: 10.1136/emermed-2013-203396 Updated information and services can be found at: http://emj.bmj.com/content/31/3/256.1
These include:
References Email alerting service
This article cites 3 articles, 1 of which you can access for free at: http://emj.bmj.com/content/31/3/256.1#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript professional organisations, including the American Medical Association, not acknowledging it as a diagnosis. Until more data are available and a physiologic explanation found, caution should be exercised when considering EXDS as a ‘cause of death.’ Jared Strote Correspondence to Dr Jared Strote, Department of Medicine, University of Washington, 1959 NE Pacific St Seattle WA 98195, Seattle, Washington 98122, USA; [email protected] Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed. To cite Strote J. Emerg Med J 2014;31:256.
Excited delirium as a potentially dangerous diagnosis To the Editor: I read with great interest Dr Huesgen’s BET on Excited Delirium (EXDS) and Sudden Death.1 Dr Huesgen summarises the complex literature well, but an important caveat debated in the literature is missing from the review. As any urban law enforcement officer or emergency physician will attest and as recent research affirms,2 the symptoms present in EXDS are seen with great frequency. The rare diagnosis can only be made retrospectively after those common symptoms are present in conjunction with unexplained death. Lacking a physiologic explanation, the use of the EXDS diagnosis risks tautology: EXDS (agitation with risk of sudden death) was present because death occurred after agitation. The implications of this are significant: if law enforcement use of force is limited by fear of harming all patients who have these symptoms, they may put themselves unnecessarily at risk. And if all agitated patients who die unexpectedly during restraint can be easily dismissed as suffering from EXDS, excessive use of force may be overlooked or excused.3 Our understanding of EXDS is severely limited by its rarity, the difficulty of gathering data in the field where most events occur and the political implications of its use. This has led to numerous medical
256
Accepted 13 November 2013 Published Online First 18 December 2013 Emerg Med J 2014;31:256. doi:10.1136/emermed-2013-203396
REFERENCES 1 2
3
Karl Huesgen. BET 1: excited delirium syndrome and sudden death. Emerg Med J 2013;30:958–60. Hall CA, Kader AS, Danielle McHale AM, et al. Frequency of signs of excited delirium syndrome in subjects undergoing police use of force: descriptive evaluation of a prospective, consecutive cohort. J Forensic Leg Med 2013;20:102–7. Ranson D. Excited delirium syndrome: a political diagnosis? J Law Med 2012;19:667–72.
Emerg Med J March 2014 Vol 31 No 3
Downloaded from http://emj.bmj.com/ on June 20, 2015 - Published by group.bmj.com
Excited delirium as a potentially dangerous diagnosis Jared Strote Emerg Med J 2014 31: 256 originally published online December 18, 2013
doi: 10.1136/emermed-2013-203396 Updated information and services can be found at: http://emj.bmj.com/content/31/3/256.1
These include:
References Email alerting service
This article cites 3 articles, 1 of which you can access for free at: http://emj.bmj.com/content/31/3/256.1#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
