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Excited Delirium: A Systematic Review.

Philippe Gonin1, Nicolas Beysard1, Bertrand Yersin1

  • 1Emergency Department, Lausanne University Hospital CHUV, Lausanne, Switzerland.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|October 10, 2017
PubMed
Summary

Excited delirium syndrome (ExDS) is a real, fatal condition with unclear definitions and risk factors like male sex and psychostimulant use. Further research is needed to establish consistent diagnostic criteria and optimal treatment strategies.

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Area of Science:

  • Medical Science
  • Public Health
  • Forensic Science

Background:

  • Excited delirium syndrome (ExDS) presents diagnostic and management challenges.
  • Existing literature lacks a universally recognized definition and consistent epidemiological data.
  • High mortality rates associated with ExDS warrant further investigation.

Purpose of the Study:

  • To define and describe the epidemiology of excited delirium syndrome.
  • To explore the pathophysiology of ExDS.
  • To summarize evidence-based treatment recommendations for ExDS.

Main Methods:

  • Systematic literature search of multiple databases (MEDLINE, Ovid, Web of Knowledge, Cochrane Library) and gray literature.
  • Independent assessment of search results and full-text articles by two investigators.
  • Classification of articles by study type, setting, and evidence level.

Main Results:

  • Incidence of ExDS varies widely; mortality is estimated between 8.3% and 16.5%.
  • Independent risk factors include male sex, young age, African-American race, and being overweight.
  • Pathophysiology hypotheses implicate dopaminergic pathways; common associations include psychostimulant use and psychiatric conditions.

Conclusions:

  • ExDS is a real clinical entity with probable specific mechanisms and risk factors, despite poor study quality and definitional inconsistencies.
  • High mortality may be influenced by definition inconsistency and reporting bias.
  • No comparative studies exist to determine the preferable treatment approach for ExDS.