Pollanen M S, Chiasson D A, Cairns J T, Young J G
University of Toronto, Ontario.
CMAJ. 1998 Jun 16;158(12):1603-7.
Some people in states of excited delirium die while in police custody. Emerging evidence suggests that physical restraint in certain positions may contribute to such deaths. In this study the authors determined the frequency of physical restraint among people in a state of excited delirium who died unexpectedly.
The authors reviewed the records of 21 cases of unexpected death in people with excited delirium, which were investigated by the Office of the Chief Coroner for Ontario between 1988 and 1995. Eyewitness testimony, findings during postmortem examinations, clinical history, toxicological data and other official documents describing the events surrounding the deaths were analyzed. Specific reference was made to documented eyewitness testimony of restraint method, body position and use of capsicum oleoresin (pepper) spray. Because cocaine was detected in the blood of some of these people during the postmortem examination, the role of cocaine in excited delirium was examined by comparing the cocaine levels in these cases with levels in 2 control groups: 19 people who died from acute cocaine intoxication and 21 people who had used cocaine shortly before they died but who had died from other causes.
In all 21 cases of unexpected death associated with excited delirium, the deaths were associated with restraint (for violent agitation and hyperactivity), with the person either in a prone position (18 people [86%]) or subjected to pressure on the neck (3 [14%]). All of those who died had suddenly lapsed into tranquillity shortly after being restrained. The excited delirium was caused by a psychiatric disorder in 12 people (57%) and by cocaine-induced psychosis in 8 (38%). Eighteen people (86%) were in police custody when they died. Four (19%) had been sprayed with capsicum oleoresin, and heart disease was found in another 4 at autopsy. The blood level of cocaine in those whose excited delirium was cocaine induced was similar to levels found in recreational cocaine users and lower than levels found in people who died from cocaine intoxication.
Restraint may contribute to the death of people in states of excited delirium, and further studies to test this hypothesis are recommended. Meanwhile, law enforcement authorities and others should bear in mind the potential for the unexpected death of people in states of excited delirium who are restrained in the prone position or with a neck hold.
一些处于兴奋谵妄状态的人在警方拘留期间死亡。新出现的证据表明，某些姿势的身体约束可能导致此类死亡。在本研究中，作者确定了意外死亡的兴奋谵妄患者中身体约束的频率。
作者回顾了1988年至1995年间安大略省首席验尸官办公室调查的21例兴奋谵妄患者意外死亡记录。分析了目击者证词、尸检结果、临床病史、毒理学数据以及描述死亡周围事件的其他官方文件。特别参考了关于约束方法、身体姿势和辣椒油树脂（胡椒）喷雾使用的书面目击者证词。由于在尸检过程中在其中一些人的血液中检测到了可卡因，通过将这些病例中的可卡因水平与2个对照组的水平进行比较，研究了可卡因在兴奋谵妄中的作用：19例死于急性可卡因中毒的人和21例在死前不久使用过可卡因但死于其他原因的人。
在所有21例与兴奋谵妄相关的意外死亡病例中，死亡均与约束（针对暴力躁动和多动）有关，患者要么处于俯卧位（18人[86%]），要么颈部受到压迫（3人[14%]）。所有死亡者在被约束后不久都突然陷入平静。12人（57%）的兴奋谵妄由精神障碍引起，8人（38%）由可卡因诱发的精神病引起。18人（86%）死亡时处于警方拘留中。4人（19%）被喷洒了辣椒油树脂，另有4人在尸检中发现患有心脏病。兴奋谵妄由可卡因诱发的患者的血液可卡因水平与娱乐性可卡因使用者的水平相似，低于死于可卡因中毒的人的水平。
约束可能导致兴奋谵妄状态的人死亡，建议进行进一步研究以验证这一假设。同时，执法当局和其他人员应牢记，处于兴奋谵妄状态且被约束在俯卧位或颈部被控制的人有意外死亡的可能性。
