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| Name | Class |
|---|---|
| U.S. Department of Justice | FED |
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The purpose of this project is to determine the levels of stress biomarkers associated with severe pain, agitation from intoxication or psychosis, and excited delirium at various levels of the disease in order to compare them to pre-clinical models of law enforcement encounters. We hypothesize that the serum catecholamines and markers of metabolic acidosis will worsen with the duration and severity of agitation among agitated patients and will not worsen among patients with severe pain who are not agitated.
Specific Aims
In this study, we propose to study Emergency Department patients under physiologic stress from severe pain, agitation, drug overdose, and excited delirium in order to compare markers of acidosis in patients at risk for unexplained-in-custody-death (UICD) in order to determine the relationship of these markers to what has been found in simulated law enforcement encounters. This information will help clarify the levels of stress associated with arrest and restraint conditions, allowing us to determine what aspects and levels of stress may be associated with the fatal mechanisms of UICD, and to identify markers that would inform death investigators of the mechanism of UICD. At the conclusion of this project, we will be able to report details explaining the relationship of the physiologic and metabolic effects of stress from restraint in excited delirium to other peri-arrest conditions and our previous work in simulated law enforcement encounters.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Agitation Group | Patients that are evaluated to have an altered mental status score greater than 1 will be enrolled in the Agitation Group. | ||
| Pain Group | Patients that report severe pain secondary to a long bone fracture or dislocation and report a visual analog scale pain score greater than 7 will be enrolled in the Pain Group. |
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| Measure | Description | Time Frame |
|---|---|---|
| Change in Altered Mental Status Score | Assessed every five minutes, from enrollment until discharge from the emergency department, an expected average time of 4 hours | |
| Change in Visual Analog Scale Pain Score | Assessed every five minutes, from enrollment until discharge from the emergency department, an expected average time of 4 hours | |
| Change in Serum Total Catecholamines | Serum dopamine, serum epinephrine, and serum norepinephrine. | Assessed every 30 minutes, from enrollment until discharge from the emergency department, an expected average time of 4 hours |
| Measure | Description | Time Frame |
|---|---|---|
| Length of Hospital Stay | Assessed at time of discharge from the hospital, an expected average of 4 hours post enrollment. | |
| Mortality | Observed for 1 year post study enrollment | |
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Agitation Group Inclusion Criteria:
Agitation Group Exclusion Criteria:
Pain Group Inclusion Criteria:
Pain Group Exclusion Criteria:
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Patients undergoing treatment for acute agitation in the emergency department of an urban Level 1 Trauma Center.
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| Name | Affiliation | Role |
|---|---|---|
| James R Miner, MD | Hennepin County Medical Center, Minneapolis | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hennepin County Medical Center | Minneapolis | Minnesota | 55415 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 30031556 | Derived | Miner JR, Klein LR, Cole JB, Driver BE, Moore JC, Ho JD. The Characteristics and Prevalence of Agitation in an Urban County Emergency Department. Ann Emerg Med. 2018 Oct;72(4):361-370. doi: 10.1016/j.annemergmed.2018.06.001. Epub 2018 Jul 19. |
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| ID | Term |
|---|---|
| D011595 | Psychomotor Agitation |
| D010146 | Pain |
| ID | Term |
|---|---|
| D020820 | Dyskinesias |
| D009461 | Neurologic Manifestations |
| D009422 | Nervous System Diseases |
| D011596 | Psychomotor Disorders |
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| Complications |
| Observed for 1 year post study enrollment |
| Change in Heart Rate | Observed from time of enrollment until discharge from the emergency department, an expected average time of 4 hours |
| Change in Systolic Blood Pressure | Observed from time of enrollment until discharge from the emergency department, an expected average time of 4 hours |
| Change in Mean Arterial Pressure | Observed from time of enrollment until discharge from the emergency department, an expected average time of 4 hours |
| Disposition | Assessed at discharge from the emergency department, an expected average of 4 hours post enrollment. |
| Change in Body Temperature | Observed from time of enrollment until discharge from the emergency department, an expected average time of 4 hours |
| Change in end tidal carbon dioxide | Assessed from time of enrollment until discharge from the emergency department, an expected average time of 4 hours |
| Change in Oxygen Saturation | Observed from time of enrollment until discharge from the emergency department, an expected average time of 4 hours |
| D019954 |
| Neurobehavioral Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D000096762 | Aberrant Motor Behavior in Dementia |
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |