Journal Article10.1136/bmjpo-2024-002525
Identifying serious underlying diagnoses among patients with brief resolved unexplained events (BRUEs): a Canadian cohort study
Nassr Nama,Zerlyn Lee,Kara Picco,Falla Jin,Jeffrey N. Bone,Julie Quet,Jessica L. Foulds,Josée Anne Gagnon,Chris Novak,Brigitte Parisien,Matthew Donlan,Ran D. Goldman,Anupam Sehgal,Ronik Kanani,Joanna Holland,P. Kyrychenko,Nardin Kirolos,Ioulia Opotchanova,Émilie Harnois,Alyse Schacter,Elisa Frizon-Peresa,Praveen Rajasegaran,Parnian Hosseini,Melody Wyslobicky,Susan Akbaroghli,Prathiksha Nalan,Sanjay Mahant,Joel S. Tieder,Peter Gill +28 more
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TL;DR: A Canadian cohort study of 1042 infants with brief resolved unexplained events (BRUE) found 7.6% had serious underlying diagnoses, primarily epilepsy/infantile spasms, and 10.8% experienced recurrent events, with low risk of adverse outcomes.
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Abstract: Objective To describe the demographics and clinical outcomes of infants with brief resolved unexplained events (BRUE). Design A retrospective cohort study. Setting 11 centres within the Canadian Paediatric Inpatient Research Network. Patients Patients presenting to the emergency department (ED) following a BRUE (2017–2021) were eligible, when no clinical cause identified after a thorough history and physical examination. Main outcome measures Serious underlying diagnosis (requiring prompt identification) and event recurrence (within 90 days). Results Of 1042 eligible patients, 665 were hospitalised (63.8%), with a median stay of 1.73 days. Diagnostic tests were performed on 855 patients (82.1%), and 440 (42.2%) received specialist consultations. In total, 977 patients (93.8%) were categorised as higher risk BRUE per the American Academy of Pediatrics guidelines. Most patients (n=551, 52.9%) lacked an explanatory diagnosis; however, serious underlying diagnoses were identified in 7.6% (n=79). Epilepsy/infantile spasms were the most common serious underlying diagnoses (2.0%, n=21). Gastro-oesophageal reflux was the most common non-serious underlying diagnosis identified in 268 otherwise healthy and thriving infants (25.7%). No instances of invasive bacterial infections, arrhythmias or metabolic disorders were found. Recurrent events were observed in 113 patients (10.8%) during the index visit, and 65 patients had a return to ED visit related to a recurrent event (6.2%). One death occurred within 90 days. Conclusions There is a low risk for a serious underlying diagnosis, where the majority of patients remain without a clear explanation. This study provides evidence-based risk for adverse outcomes, critical information to be used when engaging in shared decision-making with caregivers.
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Citations
Epidemiology of brief resolved unexplained events and impact of clinical practice guidelines in general and pediatric emergency departments
Nassr Nama,Amy M. DeLaroche,Mark I. Neuman,Manoj K. Mittal,Bruce E. Herman,Daniela Hochreiter,Ron L. Kaplan,Allayne Stephans,Joel S. Tieder +8 more
TL;DR: High incidence of BRUEs in general and pediatric EDs. CPG implementation led to decreased admissions in pediatric EDs but increased ECG use.
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Brief Resolved Unexplained Event: Evidence-Based and Family-Centered Management
Nassr Nama,Amy M. DeLaroche,Joshua L. Bonkowsky,David A. Gremse,Joel S. Tieder +4 more
TL;DR: Brief Resolved Unexplained Events (BRUEs) in infants under 1 year have low risk (<5%) of serious underlying conditions, yet 63% are hospitalized and 82% undergo unnecessary diagnostic tests, highlighting the need for family-centered management and shared decision-making.
References
Vulnerable child syndrome in everyday paediatric practice: A condition deserving attention and new perspectives.
Inge Nelly Elisabeth Verbeek,Lonneke van Onzenoort-Bokken,Sebastiaan Hermanus Johannes Zegers +2 more
TL;DR: Vulnerable child syndrome (VCS) was introduced by Green and Solnit in 1964 and described child developmental problems that originated from unsubstantiated parental fears about their child's well-being and vulnerability.
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Diagnostic testing for evaluation of brief resolved unexplained events
Manoj K. Mittal,Joel S. Tieder,K. Westphal,Erin Sullivan,Matthew Hall,Risa E. Bochner,Adam Cohen,Jennifer Colgan,Atima C. Delaney,Amy M. DeLaroche,Thomas Graf,Beth Harper,Ron L. Kaplan,Hannah C. Neubauer,Mark I. Neuman,Nirav Shastri,Victoria Wilkins,Allayne Stephans +17 more
TL;DR: In this article , a large retrospective multicenter study was conducted to determine the role of diagnostic testing in leading to a confirmatory diagnosis in brief resolved unexplained events (BRUE) patients.
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Impact of Guidelines Regarding Brief Resolved Unexplained Events on Care of Patients in a Pediatric Emergency Department.
TL;DR: Significant reduction in invasive testing, shorter lengths of ED stays, and lower admission rates at a tertiary care children's hospital after the release of the American Academy of Pediatrics BRUE guideline with no increase in return ED visits or readmissions is revealed.
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Pediatrician Perspectives on Brief Resolved Unexplained Events.
TL;DR: In this article, the authors conducted qualitative semistructured interviews with pediatric ED providers who practice in a single state to describe their perspective on the evaluation and management of brief resolved unexplained events (BRUEs) to help support the development of quality improvement interventions for this population.
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Impact of the AAP Guideline on Management of Brief Resolved Unexplained Events.
TL;DR: In this paper, the American Academy of Pediatrics published a clinical practice guideline (CPG) defining apparent life-threatening events (ALTEs) as brief resolved unexplained events (BRUEs) and recommending risk-based management.
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