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

Abstractde 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.” The basis for de Boer and colleague’s criticism of our paper is that the ExDS literature does not provide an unbiased view of the lethality of the condition, and therefore the true epidemiologic features of ExDS cannot be determined from what has been published. The criticism is unrelated to the goals or methods of the study, however. Our stated purpose was to investigate “how the term ExDS has evolved in the literature and been endowed with a uniquely lethal quality,” and whether there is “evidence for ExDS as a unique cause of a death that would have occurred regardless of restraint, or a label used when a restrained and agitated person dies, and which erroneously directs attention away from the role of restraint in explaining the death.” We cannot fathom how de Boer et al. missed this clearly stated description of the study rationale, or why they would endorse a series of fallacious and meaningless claims that gave the appearance that they failed to grasp the basic design of the study. We do acknowledge and thank these authors for pointing out 3 minor citation errors and an equally minor table formatting error (neither of which altered the reported results and conclusions in the slightest), however.

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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”

Freeman

Strömmer

Leith

et al. 2023

Forensic Sci Med Pathol

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More on: ‘the role of restraint in fatal excited delirium syndrome’

de Boer,

Fronczek,

Archer

2023

Forensic Sci Med Pathol

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Methylamphetamine toxicity and its involvement in death: A retrospective observational study of deaths reported to the Victorian Coroner, Australia

Mantinieks,

Archer,

Schumann

et al. 2023

Forensic Sci Med Pathol

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A retrospective observational study of Victorian deaths involving MA between 2010 and 2019 was conducted to determine the prevalence and contribution of methylamphetamine (MA) toxicity to death in the absence of other factors. Demographics, autopsy findings, toxicology, and the cause of death were reviewed. Coronial cases were categorized into five groups: deaths due to MA toxicity in the absence of other factors (Group A1); deaths due to MA toxicity in the setting of other potentially contributing factors (Group A2); deaths due to MA toxicity in the setting of significant natural disease (Group B); deaths primarily due to multiple-drug toxicity (Group C); and deaths primarily due to natural causes (Group D). There were 506 deaths involving MA categorized into Group A1 (n = 1, 0.6%), Group A2 (n = 8, 1.6%), Group B (n = 28, 5.5%), Group C (n = 229, 45%), and Group D (n = 240, 47%). Significant natural disease was prevalent among deaths involving MA and mainly concerned forms of cardiovascular disease (n = 277, 55%). The MA concentration in the one death included in Group A1 was 2.1 mg/L. The median MA concentrations of Group A2 (1.6 mg/L) and Group B (0.5 mg/L) were significantly higher than Group C (0.2 mg/L) and Group D (0.2 mg/L). Additionally, many other toxicologically significant drugs were detected and mostly comprised of central nervous system depressants. Deaths due to MA toxicity in the absence of other factors were rare despite the greater availability of crystal MA in the Australian community. The study highlights the interpretative challenges of MA blood concentrations and the continuing harms of this drug in Australia.

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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

Cited by 4 publications

References 35 publications

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”

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”

More on: ‘the role of restraint in fatal excited delirium syndrome’

Methylamphetamine toxicity and its involvement in death: A retrospective observational study of deaths reported to the Victorian Coroner, Australia

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