Excited delirium deaths in custody: past and present.

First identified in institutionalized psychiatric populations, chronic excited delirium syndrome was not uncommon in the first half of the 20th century. After a temporal pause, excited delirium re-emerged in the 1980s, in an acute form. Generally occurring in victims without organic mental disease, acute excited delirium is associated with stimulant abuse. This exploratory research examines the evolution of excited delirium deaths in custody to determine if medical examiner cases in Maryland reflect the historical and clinical patterns identified in the existing literature. All deaths occurring from 1939 to 2005, under the purview of the Office of the Chief Medical Examiner, were reviewed. Sixty-two custodial deaths were subsequently identified, all of which documented excited delirium as a cause of death or presented with characteristics associated with excited delirium (eg, endogenous mental disease, drug intoxication, violent behavior, paranoia, or the use of physical restraints). Consistent with extant literature, acute onset excited delirium was first identified in Maryland during the 1980s. These cases generally included violent behavior, drug intoxication, and the use of restraints. In contrast, chronic forms of excited delirium were not clearly identified. This divergent finding may be an artifact of case documentation, case inclusion criteria and/or medico-legal protocol, specific to Maryland.

Evaluation of aortic injury in driver fatalities occurring in motor vehicle accidents in the State of Maryland for 2003 and 2004.

Incorporating epidemiological and pathologic factors, a retrospective analysis of aortic injury and driving fatalities was conducted. To better understand the mechanism of injury, data were compiled for decedent demographics, autopsy and toxicology findings, and accident circumstances, with emphasis on directional impact. Review of the autopsy files of the Office of the Chief Medical Examiner in the State of Maryland in 2003 and 2004, identified 150 cases of aortic injury recorded in 537 autopsied drivers. Aortic lacerations occurred in 96% of the cases with aortic injury, two thirds of which were complete or near complete transections. A large percentage of cases involved a side impact collision. Consistent with extant research on frontal and lateral impacts, the majority of aortic injuries occurred at the ligamentum arteriosum. Also, the mechanism of aortic injury seems to be similar for side and frontal impact collisions, involving a combination of rapid deceleration forces along with chest and/or upper abdominal compression. This study emphasizes the importance of side impact collisions as a cause of aortic injury. Aortic lacerations have a high mortality rate and better motor vehicle design may prevent this type of injury.

Death in custody: a historical analysis.

This research delineates the historical evolution of death in custody. A retrospective, exploratory analysis of 145,425 cases from Maryland's Office of the Chief Medical Examiner, occurring from 1939 to 2004, was conducted. Two hundred and two custodial deaths were identified and subsequently examined relative to time, agency, decedent characteristics, and cause and manner of death. Results indicate that there have been substantive changes in custodial deaths over time. Cardiovascular disease was the most frequent cause of death from the 1930s to the 1970s, except for the 1940s, when syphilis and tuberculosis took precedence. Asphyxia, the predominant cause of death in the 1980s, reflected an increase in suicidal hangings. Emerging in the 1980s, drug intoxication deaths were prevalent in the 1990s and 2000s. Sudden unexplained deaths involving violent behavior, the use of multiple restraints, and drug intoxication were not identified until the 1980s, coinciding with periods of increased cocaine abuse nationally.