ReviewForensic science, medicine, and pathology2020
The role of restraint in fatal excited delirium: a research synthesis and pooled analysis.
Review in Forensic science, medicine, and pathology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Prioritization Patterns of Nurses in the Management of a Patient With Delirium: Results of a Q-Methodology Study.Research in nursing & health · 2025Pooled it
- Incidents of sudden death during restraint of agitated individuals in Sweden between 1992 and 2024.Journal of forensic sciences · 2026Article
- Incidence and associated factors of emergency department visits for violent behaviour: a retrospective cohort study in Romagna, Italy.BMJ open · 2026Article
- Decision-making and acute behavioural disturbance (ABD): a qualitative thematic analysis of perspectives on decision-making by UK ambulance paramedics.BMC emergency medicine · 2025Article
- Mortality Classification for Deaths With Nonfirearm Force by Police, 2012-2021.JAMA network open · 2025Article
- Response to "More on 'The role of restraint in fatal excited delirium'.Forensic science, medicine, and pathology · 2024Article
- More on: 'the role of restraint in fatal excited delirium syndrome'.Forensic science, medicine, and pathology · 2024Article
- In pursuit of inter-specialty consensus on excited delirium syndrome: a scoping literature review.Forensic science, medicine, and pathology · 2023Article
- Scrutinizing the causal link between excited delirium syndrome and restraint: a commentary on 'The role of restraint in fatal excited delirium: a research synthesis and pooled analysis' by E.M.F. Strömmer, W. Leith, M.P. Zeegers, and M.D. Freeman.Forensic science, medicine, and pathology · 2023Article
- Response to "Scrutinizing the causal link between excited delirium syndrome and restraint - a commentary on: 'The role of restraint in fatal excited delirium: a research synthesis and pooled analysis' by E.M.F. Strömmer, W. Leith, M.P. Zeegers and M.D. Freeman".Forensic science, medicine, and pathology · 2023Article
- Prone restraint cardiac arrest in in-custody and arrest-related deaths.Journal of forensic sciences · 2022Article
- Hospital Restraints: Safe or Dangerous? A Case of Hospital Death Due to Asphyxia from the Use of Mechanical Restraints.International journal of environmental research and public health · 2022Article
- 'Excited Delirium', acute behavioural disturbance, death and diagnosis.Psychological medicine · 2022Review
- Adverse events following emergent prehospital sedation of patients with behavioral emergencies: A retrospective cohort study.Lancet regional health. Americas · 2022Article
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The purpose of the present study was to perform a comprehensive scientific literature review and pooled data risk factor analysis of excited delirium syndrome (ExDS) and agitated delirium (AgDS). All cases of ExDS or AgDS described individually in the literature published before April 23, 2020 were used to create a database of cases, including demographics, use of force, drug intoxication, mental illness, and survival outcome. Odds ratios were used to quantify the association between death and diagnosis (ExDS vs. AgDS) across the covariates. There were 61 articles describing 168 cases of ExDS or AgDS, of which 104 (62%) were fatal. ExDS was diagnosed in 120 (71%) cases, and AgDS in 48 (29%). Fatalities were more likely to be diagnosed as ExDS (OR: 9.9, p < 0.0001). Aggressive restraint (i.e. manhandling, handcuffs, and hobble ties) was more common in ExDS (ORs: 4.7, 14, 29.2, respectively, p < 0.0001) and fatal cases (ORs: 7.4, 10.7, 50, respectively, p < 0.0001). Sedation was more common in AgDS and survived cases (OR:11, 25, respectively, p < 0.0001). The results of the study indicate that a diagnosis of ExDS is far more likely to be associated with both aggressive restraint and death, in comparison with AgDS. There is no evidence to support ExDS as a cause of death in the absence of restraint. These findings are at odds with previously published theories indicating that ExDS-related death is due to an occult pathophysiologic process. When death has occurred in an aggressively restrained individual who fits the profile of either ExDS or AgDS, restraint-related asphyxia must be considered a likely cause of the death.
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