Hyperactive Delirium

Hyperactive delirium syndrome is a life-threatening constellation of symptoms manifested as a clinical syndrome. The combination of vital sign abnormalities, metabolic derangements, altered mental status/agitation, and potential physical trauma raises serious concerns for impending danger. Patients with this condition are at high risk of direct physical trauma, not only unintentional harm from trauma such as falls, but also the secondary physical trauma that may result from physical restraint to allow for evaluation of the patient by emergency personnel.

During the summer of 2020, ACEP heard urgent questions surrounding initial management of hyperactive delirium presenting with severe agitation raised by its membership, the scientific community at large, community leaders, media, and governmental agencies. In response, ACEP President Dr. William Jaquis appointed a task force to draft a report synthesizing the most current information available regarding the recognition, evaluation, and management of patients in the prehospital or emergency department setting presenting with hyperactive delirium accompanied by severe agitation.