Stress Biomarkers Among Patients Undergoing Treatment for Excited Delirium and Severe Pain in the Emergency Department

This award was competitively made in response to a proposal submitted by the Minneapolis Medical Research Foundation to an NIJ FY2012 solicitation "Determining the Relationship Between Stress and Unexplained In-Custody Deaths". This project is part of a larger NIJ-funded research effort looking into the potential for the physiologic and metabolic effects of stress to be a cause for otherwise unexplained in-custody deaths. This research effort seeks to: (1) clarify the fatal mechanisms that might be associated with stress resulting from being subdued or restrained, by any means and not limited to CEDs; and, if such mechanisms can be demonstrated, (2) identify post-mortem markers that can inform death investigations. In this study, the Minneapolis Medical Research Foundation proposes to study Emergency Department patients who have agitation in order to determine the characteristics and prevalence of the condition of excited delirium and to determine the degree of physiologic stress in a subset of these patients in order to determine the relationship of acidosis and stress to what has been found in previous research of simulated law enforcement encounters. In addition, they will study a comparative group of patients with severe pain from long bone fractures in order to compare markers of acidosis and stress among agitated patients to patients who have stress without agitation. This information will help clarify the levels of stress associated with arrest and restraint conditions, allowing the proposers to determine what aspects and levels of stress may be associated with the fatal mechanisms of unexplained in-custody deaths (UICD) and to identify markers that would inform death investigators of the mechanism of UICD. ca/ncf