Excited Delirium: A Systematic Review.

Détails

ID Serval
serval:BIB_D15068D983ED
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Excited Delirium: A Systematic Review.
Périodique
Academic emergency medicine
Auteur(s)
Gonin P., Beysard N., Yersin B., Carron P.N.
ISSN
1553-2712 (Electronic)
ISSN-L
1069-6563
Statut éditorial
Publié
Date de publication
05/2018
Peer-reviewed
Oui
Volume
25
Numéro
5
Pages
552-565
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
We aimed to clarify the definition, epidemiology, and pathophysiology of excited delirium syndrome (ExDS) and to summarize evidence-based treatment recommendations.
We conducted a systematic literature search of MEDLINE, Ovid, Web of Knowledge, and Cochrane Library for articles published to March 18, 2017. We also searched the gray literature (Google Scholar) and official police or medical expert reports to complete specific epidemiologic data. Search results and full-text articles were independently assessed by two investigators and agreements between reviewers assessed with K statistics. We classified articles by study type, setting, and evidence level.
After reviewing the title and abstract of 3,604 references, we fully reviewed 284 potentially relevant references, from which 66 were selected for final review. Six contributed to the definition of ExDS, 24 to its epidemiology, 38 to its pathophysiology, and 27 to its management. The incidence of ExDS varies widely with medical or medicolegal context. Mortality is estimated to be as much as 8.3% to 16.5%. Patients are predominantly male. Male sex, young age, African-American race, and being overweight are independent risk factors. Pathophysiology hypotheses mostly implicate dopaminergic pathways. Most cases occur with psychostimulant use or among psychiatric patients or both. Proposed treatments are symptomatic, often with rapid sedation with benzodiazepines or antipsychotic agents. Ketamine is suggested as an alternative.
The overall quality of studies was poor. A universally recognized definition is lacking, remaining mostly syndromic and based on clinical subjective criteria. High mortality rate may be due to definition inconsistency and reporting bias. Our results suggest that ExDS is a real clinical entity that still kills people and that has probably specific mechanisms and risk factors. No comparative study has been performed to conclude whether one treatment approach is preferable to another in the case of ExDS.
Mots-clé
Agitation, Emergency, Epidemiology, Excited delirium syndrome, Ketamine, Pathophysiology, treatment
Pubmed
Web of science
Création de la notice
19/10/2017 9:36
Dernière modification de la notice
23/06/2018 6:26
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