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

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.

Survey of parental willingness to pay and willingness to stay for "painless" intravenous catheter placement.

OBJECTIVES: This study examined how much parents are willing to pay and/or willing to stay to make their child's intravenous (IV) catheter placement painless. METHODS: A prospective survey was conducted using a questionnaire administered to a consecutive sample of parents presenting to an emergency department (ED). Eligible subjects were parents accompanying a child 8 years of age or younger. A hypothetical visit to the ED, requiring an IV for their child, was described. Parents were asked if they would prefer to make the IV catheter placement painless and if so, how much of an increase in out-of-pocket cost (none, 15 dollars, and 100 dollars) and/or length of stay they would be willing to incur (no time, 15 minutes, 1 hour). Statistics were chiefly descriptive. Associations of demographic elements with willingness to pay and willingness to stay were analyzed using chi and t tests, where appropriate. RESULTS: One hundred eight subjects were available for analysis. Most parents were mothers (71%), white (53%), and with previous IVs (70%). Most children were boys (55%) with no previous IV placements (55%). The choice of a painless IV placement was independent of demographics and IV experience. Most parents (89%) chose a painless IV placement. Of these parents, 65% chose a willingness to stay of 1 extra hour, and 77% a willingness to pay at least 15 dollars; 37% of parents would pay 100 dollars. Willingness to pay was dependent on both income (P = 0.014) and ethnicity (P = 0.0013). Willingness to stay was independent of both income (P = 0.24) and ethnicity (P = 0.07). CONCLUSIONS: Parents are willing to spend both time and money to make their child's IV placement painless. This information should be considered when choosing therapies to reduce the pain of IV placement.