There is no definitive diagnostic, or gold standard, test for ABD. Diagnosis is made on clinical features and exclusion of alternative disease processes. This makes determination of incidence difficult as does the fact that a number of terms are used to describe the same clinical entity.

In response to the death of a young male in London in 2011 from acute cocaine toxicity and over exertion following prolonged physical restraint, the Coroner responsible for the case recommended that key agencies such as the Metropolitan Police Service, London Ambulance Service and the NHS adopt a single description for this constellation of symptoms. The aim of this was to ensure that ABD is identified promptly, and recognised as a medical emergency; that sedation by trained health professionals is instigated early to gain control of the situation, and to prevent the death of the patient.

Subsequent to this Prevention of Future Deaths report (regulation 28) it has been widely accepted that the term Acute Behavioural Disturbance is used by personnel working within EDs and when communicating with, and working alongside, Police and Ambulance Services.

The term Excited Delirium Syndrome is used more commonly in the United States of America.

Learning Bite

The term Acute Behavioural Disturbance (ABD) should be used to facilitate multi-agency communication and response to this medical emergency.