重新审视“兴奋谵妄”：该诊断是否反映并加剧了种族偏见？
Revisiting "Excited Delirium": Does the Diagnosis Reflect and Promote Racial Bias?
机构信息
Bridgeport Hospital, Yale-New Haven Health System, Department of Emergency Medicine, Bridgeport, Connecticut.
University of Chicago, Northshore University Health System, Department of Emergency Medicine, Chicago, Illinois.
出版信息
West J Emerg Med. 2023 Jan 31;24(2):152-159. doi: 10.5811/westjem.2022.10.56478.
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.
引言
“兴奋性谵妄”（ExD）据称代表了一种可能导致意外死亡的特定激越状态。美国急诊医师学院（ACEP）兴奋性谵妄工作组撰写的 2009 年“兴奋性谵妄综合征白皮书报告”继续在定义 ExD 方面发挥关键作用。自该报告发布以来，人们越来越意识到该标签更多地被用于黑人。
方法
我们的目的是分析 2009 年报告的语言、潜在刻板印象的作用以及可能潜在鼓励偏见的机制。
结果
我们对 2009 年报告中提出的 ExD 诊断标准的评估表明，它依赖于持续的种族刻板印象：例如，异常强壮、对疼痛的敏感性降低和怪异行为。研究表明，使用此类刻板印象可能会鼓励有偏见的诊断和治疗。
结论
我们建议急诊医学界避免使用 ExD 这一概念，并且 ACEP 应撤回对该报告的隐含或明确支持。
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