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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.
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http://dx.doi.org/10.1007/s12024-022-00548-4 | DOI Listing |
ArXiv
August 2024
Laboratory for Translational Imaging of Microcirculation, Indiana University School of Medicine, Indianapolis, IN, USA.
Background: Fully automatic analysis of myocardial perfusion MRI datasets enables rapid and objective reporting of stress/rest studies in patients with suspected ischemic heart disease. Developing deep learning techniques that can analyze multi-center datasets despite limited training data and variations in software (pulse sequence) and hardware (scanner vendor) is an ongoing challenge.
Methods: Datasets from 3 medical centers acquired at 3T (n = 150 subjects; 21,150 first-pass images) were included: an internal dataset (inD; n = 95) and two external datasets (exDs; n = 55) used for evaluating the robustness of the trained deep neural network (DNN) models against differences in pulse sequence (exD-1) and scanner vendor (exD-2).
J Cardiovasc Magn Reson
December 2024
Laboratory for Translational Imaging of Microcirculation, Indiana University School of Medicine, Indianapolis, Indiana, USA; Elmore Family School of Electrical and Computer Engineering, Purdue University, West Lafayette, Indiana, USA; Krannert Cardiovascular Research Center, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette and Indianapolis, IN, USA. Electronic address:
Background: Fully automatic analysis of myocardial perfusion cardiovascular magnetic resonance imaging datasets enables rapid and objective reporting of stress/rest studies in patients with suspected ischemic heart disease. Developing deep learning techniques that can analyze multi-center datasets despite limited training data and variations in software (pulse sequence) and hardware (scanner vendor) is an ongoing challenge.
Methods: Datasets from three medical centers acquired at 3T (n = 150 subjects; 21,150 first-pass images) were included: an internal dataset (inD; n = 95) and two external datasets (exDs; n = 55) used for evaluating the robustness of the trained deep neural network (DNN) models against differences in pulse sequence (exD-1) and scanner vendor (exD-2).
Stud Hist Philos Sci
April 2024
University of Twente, Drienerlolaan 5, 7522 NB Enschede, the Netherlands. Electronic address:
"Excited Delirium Syndrome" (ExDS) is a controversial diagnosis. The supposed syndrome is sometimes considered to be a potential cause of death. However, it has been argued that its sole purpose is to cover up excessive police violence because it is mainly used to explain deaths of individuals in custody.
View Article and Find Full Text PDFForensic Sci Med Pathol
December 2023
Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands.
de Boer et al. criticize the conclusions in our 2020 paper on the validity of Excited Delirium Syndrome (ExDS) as "egregiously misleading." Our conclusion was that there "is no existing evidence that indicates that ExDS is inherently lethal in the absence of aggressive restraint.
View Article and Find Full Text PDFJ Nerv Ment Dis
May 2023
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Citizens' deaths in police custody are sometimes attributed to "excited delirium syndrome" (ExDS). This terminology is rejected by the American Medical Association and the American Psychiatric Association. ExDS has no demonstrable pathology but has been proposed as predisposing to sudden death, thus exonerating police.
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