Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan 31;24(2):152-159.
doi: 10.5811/westjem.2022.10.56478.

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

Brooks Myrick Walsh  1 , Isaac K Agboola  2 , Edouard Coupet Jr  3 , John S Rozel  4 , Ambrose H Wong  3
Affiliations

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

Brooks Myrick Walsh et al. West J Emerg Med. .

Abstract

Introduction: "Excited delirium" (ExD) is purported to represent a certain type of agitated state that can lead to unexpected death. The 2009 "White Paper Report on Excited Delirium Syndrome," authored by the American College of Emergency Medicine (ACEP) Excited Delirium Task Force, continues to play a pivotal role in defining ExD. Since that report was produced, there has been an increasing appreciation that the label has been applied more often to Black people.

Methods: Our aim was to analyze the language of the 2009 report, the role of potential stereotypes, and the mechanisms that may potentially encourage bias.

Results: Our evaluation of the diagnostic criteria for ExD proposed in the 2009 report shows that it relies on persistent racial stereotypes: eg, unusual strength, decreased sensitivity to pain, and bizarre behavior. Research indicates that use of such stereotypes could encourage biased diagnosis and treatment.

Conclusion: We suggest that the emergency medicine community avoid use of the concept ExD and that ACEP withdraw implicit or explicit support of the report.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

References

    1. DeBard ML, Adler J, Bozeman W, et al. White Paper Report on Excited Delirium Syndrome. 2009. [Accessed April 20, 2021]. Available at: https://www.prisonlegalnews.org/news/publications/acep-report-on-excited...
    1. Hatten B. ACEP Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings. 2021. [Accessed October 6, 2021]. Available at: https://www.acep.org/by-medical-focus/hyperactive-delirium/
    1. da Silva Bhatia B, Heisler M, Naples-Mitchell J, et al. Excited Delirium” and Deaths in Police Custody Physicians for Human Rights. [Accessed March 4, 2022]. https://phr.org/our-work/resources/excited-delirium/ - PubMed
    1. ACEP. Non-Discrimination and Harassment Policy Statement. 2021. [Accessed August 24, 2022]. Available at: https://www.acep.org/patient-care/policy-statements/non-discrimination-a...
    1. ACEP. 5-30-20 ACEP Statement on Structural Racism and Public Health. [Accessed December 25, 2020]. Available at: http://www.emergencyphysicians.org/press-releases/2020/5-30-20-acep-stat....