Revisiting "Excited Delirium": Does the Diagnosis Reflect and Promote Racial Bias?

Area of Science:

• Medical ethics
• Emergency medicine
• Sociology of race

Background:

• "Excited delirium" (ExD) is a controversial concept linked to sudden death.
• The 2009 American College of Emergency Medicine (ACEP) report significantly shaped the definition of ExD.
• Concerns exist regarding the disproportionate application of the ExD label to Black individuals.

Purpose of the Study:

• To critically analyze the language and diagnostic criteria of the 2009 ACEP ExD report.
• To investigate the role of racial stereotypes in the ExD concept.
• To identify mechanisms that may foster diagnostic and treatment bias.

Main Methods:

• Linguistic analysis of the 2009 ACEP report.
• Examination of diagnostic criteria for potential bias.
• Review of research on stereotype-driven medical decision-making.

Main Results:

• The 2009 ExD report's criteria incorporate racial stereotypes (e.g., unusual strength, pain insensitivity, bizarre behavior).
• These stereotypes can contribute to biased diagnosis and treatment in emergency settings.
• Evidence suggests a pattern of disproportionate application of the ExD label to Black individuals.

Conclusions:

• The emergency medicine community should cease using the "excited delirium" concept.
• ACEP should retract its endorsement of the 2009 report.
• Re-evaluation of ExD is necessary to address potential racial bias in emergency care.