NORTHFIELD, Ill. (October 13, 2023) — “Excited delirium” is not a medical diagnosis and should no longer be used as a cause of death. The College of American Pathologists (CAP) supports this recent position issued by the National Association of Medical Examiners (NAME). This position is also supported by the American Medical Association and the American Psychiatric Association.
The terms excited delirium and excited delirium syndrome have been used to describe a pathophysiologic process that may occur in individuals often under the influence of drugs or other substances, characterized by extreme agitation, high body temperature, and unexpected strength. “This terminology has been used by medical examiners, forensic pathologists, and law enforcement personnel,” explained Michelle Aurelius, MD, FCAP, chair of the CAP’s Forensic Pathology Committee. “However, there are concerns that use of this term can mask physical restraint use and that this terminology targets persons of color.”
Furthermore, excited delirium and excited delirium syndrome are not terms endorsed by NAME or recognized as medical diagnoses in renewed classifications of the WHO, ICD-10, and DSM-V and therefore, should not be listed as the cause of death. “Instead, NAME endorses—and CAP supports—that the death certificate list the underlying cause of death, natural or unnatural (to include trauma),” said Dr. Aurelius. “If possible, the underlying cause should be determined and used for death certification.”
About the College of American Pathologists
As the world’s largest organization of board-certified pathologists and leading provider of laboratory accreditation and proficiency testing programs, the College of American Pathologists (CAP) serves patients, pathologists, and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide. For more information, visit the CAP Newsroom, CAP.org and yourpathologist.org to watch pathologists at work and see the stories of the patients who trust them with their care.
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