BRUE – A Game Changer?

Written by Clay Smith

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Since the AAP released new guidelines on brief resolved unexplained events (BRUE), there has been a decrease in admission and diagnostic testing in these patients.

Why does this matter?
Guidelines on managing BRUE were released in 2016. This is a helpful way to risk stratify these patients. I find it hard to remember the criteria and rely on MDCalc to help me. What has been the effect of the new BRUE?

What’s new, BRUE?
This was a before and after study of 9,501 infants on the management of BRUE in 2017 compared to ALTE (apparent life-threatening event) in 2015. New AAP BRUE guidelines were released in 2016. Admission rates dropped 5.7% in infants 0-60 days and 18% in those 61-365 days of age. There was also a decrease in the amount of diagnostic testing, such as EEG, MRI, CXR, and labs. This change in practice appeared to be safe, as there was no statistical increase in repeat visits or subsequent high-acuity diagnoses in the 2017 compared to 2015 cohorts.

Source
Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs). Pediatrics. 2019 Sep 5. pii: e20190375. doi: 10.1542/peds.2019-0375. [Epub ahead of print]

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Reviewed by Thomas Davis