Response to “More on ‘The role of restraint in fatal excited delirium’

Excerpt

Following our review of the second commentary from de Boer et al. regarding our 2020 publication in FSMP on excited delirium syndrome (ExDS) [1], we find that it largely consists of a rehashing of the same misguided and picayune complaints and grievances that they aired in their first commentary [2]. While we appreciate these authors’ enthusiasm for the topic, it seems that their energies would be better suited to writing their own review and analysis of the ExDS literature using their own methods, rather than continuing to repeat the same erroneous criticisms of our methods and results. As we noted in our point-by-point response to their prior lengthy critique of our paper [3], we performed the research and analysis that we set out to do, which was to assay the literature supporting ExDS as a unique cause of death. Our results conclusively demonstrated that there is no scientifically valid basis for the presumption that ExDS is a stand-alone cause of death. de Boer and colleagues’ dissatisfaction with our methods and conclusions notwithstanding, we accomplished our research goal, and were able to demonstrate that ExDS is a confounding term in medicolegal death investigation, and should be abandoned. When a death occurring during prone restraint is attributed to ExDS, it is more likely due to the established asphyxial effects of aggressive prone restraint, versus the baseless belief in an unknown pathophysiologic process for which there is no evidence at autopsy. de Boer and colleagues seem to suggest that we are throwing out the baby with the bathwater and that ExDS should still be considered a potential competing cause of death when an individual who is aggressively restrained in a prone position dies in custody. As we have noted in our prior response to these authors, as well as in our original publication, the state of scientific evidence strongly indicates that there is no baby, only bathwater. The myth of ExDS as a pathophysiologic cause of death that can be preferentially selected over aggressive prone restraint has been thoroughly debunked in the scientific literature, and is unlikely to be resurrected. …