Explanatory Diagnoses Following Hospitalization for a Brief Resolved Unexplained Event

Bochner, Risa; Tieder, Joel S.; Sullivan, Erin; Hall, Matt; Stephans, Allayne; Mittal, Manoj K.; Singh, Nidhi; Delaney, Atima C; Harper, Beth D.; Shastri, Nirav; Hochreiter, Daniela; Neuman, Mark I.

doi:10.1542/peds.2021-052673

Cited by 14 publications

(17 citation statements)

References 13 publications

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“…There are only 9 studies in the literature that investigate BRUE/ALTE and ED usage. [10][11][12][13][14][15][16][17][18] Usage focused on clinical characteristics in a handful of studies. 12,13,16,18 None of these studies examined the role of potential social determinants.…”

Section: Discussionmentioning

confidence: 99%

A Descriptive Analysis

McHale,

Siddique,

Gienapp

et al. 2024

Pediatr Emer Care

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Objectives Infants presenting to pediatric emergency departments (EDs) after a choking episode, cyanotic event, or irregular breathing pattern are often diagnosed with a brief, resolved, unexplained event (BRUE). Social determinants of health may affect these patients; therefore, we aimed to define population demographics and determine significant demographic predictors between 2 cohorts—infants presenting with BRUE, and those admitted to the intensive care unit. Methods Using data from the Pediatric Health Information System (Children's Hospital Association, Washington, DC, Lenexa, KS), this multicenter, retrospective study included children aged 0–1 year from 52 hospitals who presented with an International Classification of Diseases-10 coded primary diagnosis for BRUE/apparent life-threatening event (ALTE) between January 1, 2016, and June 30, 2021. Cohort 1 patients presented to the ED with BRUE; cohort 2 patients were admitted from the ED for BRUE. Univariate and multivariate logistic regression were performed for both cohorts to discover possible demographic predictors. Results Overall, 24,027 patients were evaluated. Patient sex did not affect admission rates (odds ratio [OR] = 1.034; 95% confidence interval [CI], 0.982–1.089; P = 0.2051). Black race (OR = 1.252; 95% CI, 1.177–1.332; P < 0.0001) and Medicaid insurance (OR = 1.126; 95% CI, 1.065–1.19; P < 0.0001) were significantly associated with an increased risk of admission. “Other” race (OR = 0.837; 95% CI, 0.777–0.902; P < 0.0001) and commercial insurance were significantly associated with a greater likelihood of discharge (OR = 0.888; 95% CI, 0.84–0.939; P < 0.0001). Conclusions Black race and Medicaid insurance predicted admission in this patient population, but demographics did not play a role in intensive care unit admission overall. Social determinants of health and demographics therefore appeared to play a role in admission for patients presenting to the ED. Future research could evaluate the effect of focused interventions, such as providing additional resources to socially at-risk families through community outreach, on admission rates of patients with these specific at-risk demographics.

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Section: Discussionmentioning

confidence: 99%

A Descriptive Analysis

McHale,

Siddique,

Gienapp

et al. 2024

Pediatr Emer Care

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“…In 2017, the Italian Society of Pediatrics updated its own guidelines and accepted the new acronym BRUE for lower-risk idiopathic episodes, while keeping the term ALTE for severe idiopathic episodes that are only solved after resuscitation maneuvers and related to patient instability, prematurity (<32 weeks of gestational age and <43 weeks of postconceptional age), age below two months, need for resuscitation maneuvers, recurrence, and poor family compliance [51,53]. Clinical evaluation of children with BRUE showed that, in the great majority, children with this diagnosis have very mild disease that does not require hospital admission for further tests [59,60].…”

Section: Apparent Life-threating Event (Alte) and Brief Resolved Unex...mentioning

confidence: 99%

Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE)

Sodini

Paglialonga

Antoniol

et al. 2022

Life

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Sudden infant death syndrome (SIDS) is defined as the sudden death of an infant younger than one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. About 90% of SIDS occur before six months of age, the peak incidence is between two and four months, and the median age for death is elven weeks. The clinical, social, and economic relevance of SIDS, together with the evidence that prevention of this syndrome was possible, has significantly stimulated research into risk factors for the development of SIDS in the hope of being able to introduce new effective preventive measures. This narrative review discusses the potential relationships between apparent life-threatening events (ALTE) or brief resolved unexplained events (BRUE) and SIDS development, and when a home cardiorespiratory monitor is useful for prevention of these conditions. A literature analysis showed that home cardiorespiratory monitoring has been considered a potential method to identify not only ALTE and BRUE but SIDS also. ALTE and BRUE are generally due to underlying conditions that are not detectable in SIDS infants. A true relationship between these conditions has never been demonstrated. Use of home cardiorespiratory monitor is not recommended for SIDS, whereas it could be suggested for children with previous ALTE or severe BRUE or who are at risk of the development of these conditions. However, use of home cardiorespiratory monitors assumes that family members know the advantages and limitations of these devices after adequate education and instruction in their use.

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“…Following the publication of the AAP guidelines, studies showed that while the majority of infants presenting with a BRUE (87%–92%) met at least one higher-risk criteria, only a small proportion have a serious underlying diagnosis (4%) 2 6–8. Analysis of the AAP criteria identified a history of a similar event, event clusters, CPR use and abnormal medical history to be associated with a serious underlying diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…In 2018, 15 children’s hospitals across the USA convened to create BRUE Quality Improvement and Research Collaborative (BRUE-QIRC) network 6–8 10 11. Using an administrative database (Pediatric Health Information System), the collaboration was able to retrospectively identify the largest cohort of patients with BRUE described to date (n=3283).…”

Section: Introductionmentioning

confidence: 99%

“…The collaborative developed and validated an approach to identifying BRUE patients based on diagnostic codes 10. Furthermore, they were able to describe the cohort’s characteristics,6 any identified diagnoses7 and the yield of diagnostic testing in this population 11. Work by the BRUE-QIRC demonstrated the AAP guidelines have a 98% negative predictive value (NPV) for identifying a serious underlying medical condition, but only had a 5% positive predictive value (PPV) 8.…”

Section: Introductionmentioning

confidence: 99%

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Canadian infants presenting with Brief Resolved Unexplained Events (BRUEs) and validation of clinical prediction rules for risk stratification: a protocol for a multicentre, retrospective cohort study

et al. 2022

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IntroductionBrief Resolved Unexplained Events (BRUEs) are a common presentation among infants. While most of these events are benign and self-limited, guidelines published by the American Academy of Pediatrics inaccurately identify many patients as higher-risk of a serious underlying aetiology (positive predictive value 5%). Recently, new clinical prediction rules have been derived to more accurately stratify patients. This data were however geographically limited to the USA, with no large studies to date assessing the BRUE population in a different healthcare setting. The study’s aim is to describe the clinical management and outcomes of infants presenting to Canadian hospitals with BRUEs and to externally validate the BRUE clinical prediction rules in identified cases.Methods and analysisThis is a multicentre retrospective study, conducted within the Canadian Paediatric Inpatient Research Network (PIRN). Infants (<1 year) presenting with a BRUE at one of 11 Canadian paediatric centres between 1 January 2017 and 31 December 2021 will be included. Eligible patients will be identified using diagnostic codes.The primary outcome will be the presence of a serious underlying illness. Secondary outcomes will include BRUE recurrence and length of hospital stay. We will describe the rates of hospital admissions and whether hospitalisation was associated with an earlier diagnosis or treatment. Variation across Canadian hospitals will be assessed using intraclass correlation coefficient. To validate the newly developed clinical prediction rule, measures of goodness of fit will be evaluated. For this validation, a sample size of 1182 is required to provide a power of 80% to detect patients with a serious underlying illness with a significance level of 5%.Ethics and disseminationEthics approval has been granted by the UBC Children’s and Women’s Research Board (H21-02357). The results of this study will be disseminated as peer-reviewed manuscripts and presentations at national and international conferences.

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Explanatory Diagnoses Following Hospitalization for a Brief Resolved Unexplained Event

Cited by 14 publications

References 13 publications

A Descriptive Analysis

A Descriptive Analysis

Home Cardiorespiratory Monitoring in Infants at Risk for Sudden Infant Death Syndrome (SIDS), Apparent Life-Threatening Event (ALTE) or Brief Resolved Unexplained Event (BRUE)

Canadian infants presenting with Brief Resolved Unexplained Events (BRUEs) and validation of clinical prediction rules for risk stratification: a protocol for a multicentre, retrospective cohort study

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