The relationship between positional asphyxia and increasing body mass index

Byard, Roger W.

doi:10.1016/j.legalmed.2020.101678

Cited by 10 publications

(1 citation statement)

References 17 publications

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“…10 It is significant in the current cases that both victims had experienced mobility issues involving alcoholism with falls, osteoarthritis with joint surgery, and Parkinson disease. Although there has been an association demonstrated between an increased risk of positional asphyxia and obesity, 11 it is not something that has been focused on in the literature on lethal falls from beds in the elderly 12 ; however, it is likely that obesity could further impair movement in an individual with mobility issues. Cognitive impairment may also be an issue, which may result in an entrapped individual not fully understanding the dangers of a situation and/or not being able to appropriately self-rescue.…”

Section: Discussionmentioning

confidence: 99%

Continued Dangers From Bed Pole Mobility Devices

Byard

Ritchey

2021

Am J Forensic Med Pathol

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Bed poles are held in place by a frame that is inserted underneath a bed mattress and are designed to assist in moving an incumbent from a lying to an upright sitting position, or to help with turning, repositioning, or transferring. Two cases demonstrate, however, that lethal entrapment may be caused by such devices-a 76-year-old man and an 84-year-old woman were both found beside their beds hanging by their necks from bed poles. Gaps between bed poles and mattress/bed sides may provide potentially lethal confined spaces. Individuals at particular risk of such an event are elderly with limited strength and/or obesity with an incomplete awareness of environmental dangers and have a history of mobility issues and/or falls. Any railing used to assist with movement to and from, or within, a bed must sit flush with the bed/mattress side to minimize any chances of entrapment.

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Section: Discussionmentioning

confidence: 99%

Continued Dangers From Bed Pole Mobility Devices

Byard

Ritchey

2021

Am J Forensic Med Pathol

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The role of restraint in fatal excited delirium: a research synthesis and pooled analysis

Strömmer

Leith

Zeegers

et al. 2020

Forensic Sci Med Pathol

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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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