Retrospective Application of BRUE Criteria to Patients Presenting With ALTE

To apply recently published brief resolved unexplained events (BRUE) guidelines to patients who presented with apparent life-threatening event (ALTE) to determine: (1) characteristics of these patients; (2) which patients meet BRUE criteria, including risk stratification; and (3) patient outcomes.

A retrospective chart review of patients presenting to the emergency department or directly to the inpatient unit of a community hospital was performed over the 3 years preceding publication of BRUE guidelines. International Classification of Diseases, Ninth Revision and International Classification of Diseases, 10th Revision billing data for infants <1 year of age were used to screen for patients. After 2-physician review, patients presenting with ALTE diagnostic criteria were identified. Characteristics of the patients and event were analyzed.

A total of 321 charts were screened, of which 87 patients were determined to have been diagnosed with ALTE. Twenty patients (23%) met criteria for diagnosis of BRUE. Only 1 patient met criteria for lower-risk BRUE. Of patients with ALTE, 79% of patients presented to the emergency department, of which 65% were admitted, 25% were discharged from the hospital, and 9% were transferred to a tertiary care hospital. Of the 63 inpatients, most were discharged from the hospital after brief observation, and 5% required transfer to a higher level of care.

The majority of patients with ALTE presenting to this institution did not meet the BRUE definition primarily because of ongoing symptoms and/or a specific diagnosis explaining the event. With this finding, we highlight the importance of characterizing the events on the basis of history and physical examination when diagnosing and caring for these patients.