Brief Resolved Unexplained Event: Not Just a New Name for... : Pediatric Emergency Care (original) (raw)

Original Articles

Not Just a New Name for Apparent Life-Threatening Event

Gerber, Nicole L. MD∗; Fawcett, Kelsey J. MD†; Weber, Emily G. MD‡; Patel, Roshni MD§; Glick, Alexander F. MD, MS§; Farkas, Jonathan S. MD§; Mojica, Michael A. MD∥

From the ∗Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York Presbyterian–Weill Cornell Medical Center

†Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York Presbyterian–Columbia University Medical Center, New York

‡Department of Emergency Medicine, SUNY Downstate Medical Center–Kings County Hospital Center, Brooklyn

§Department of Pediatrics

∥Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York University School of Medicine/NYU Langone Health/Bellevue Hospital Center, New York, NY.

Disclosure: The authors declare no conflict of interest.

Reprints: Nicole L. Gerber, MD, New York Presbyterian Hospital, Komansky Children's Hospital, 525 East 68th St, M130, New York, NY 10021 (e-mail: [email protected]).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.pec-online.com).

Abstract

Objectives

This study aimed to evaluate patients who presented to the pediatric emergency department with an apparent life-threatening event (ALTE) to (1) determine if these patients would meet the criteria for brief resolved unexplained event (BRUE), a new term coined by the American Academy of Pediatrics in May, 2016; (2) risk stratify these patients to determine if they meet the BRUE low-risk criteria; and (3) evaluate outcomes of patients meeting the criteria for BRUE.

Methods

We conducted a retrospective chart review of patients who presented to a large urban academic center pediatric emergency department with an ALTE from January 2013 to May 2015 (before the publication of the BRUE guideline). Children ≤12 months of age were identified by the International Classification of Diseases, Ninth/Tenth Revision. Two physician reviews were performed to determine if patients met the ALTE diagnostic criteria. Data were then extracted from these charts to complete objectives.

Results

Seventy-eight patients met the diagnostic criteria for ALTE. Only 1 of those patients met the diagnostic criteria for BRUE, but not for low-risk BRUE. This patient underwent an extensive inpatient evaluation and was eventually discharged after monitoring with a benign diagnosis. Most patients did not meet the criteria for BRUE because the event was not unexplained.

Conclusions

Only 1 patient who presented to the ED with ALTE met the criteria for BRUE, and this patient did not meet the low-risk criteria. This study corroborates previous research on BRUE and continues to highlight the importance of conducting a thorough history and physical examination on all patients presenting to the ED with concerning events.