Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs)

Area of Science:

• Pediatric Emergency Medicine
• Clinical Practice Guidelines
• Infant Health Outcomes

Background:

• In May 2016, the American Academy of Pediatrics released a clinical practice guideline for brief resolved unexplained events (BRUEs).
• The guideline aimed to standardize the management of BRUEs in pediatric patients.
• This study evaluated the impact of the guideline on clinical management practices.

Purpose of the Study:

• To assess changes in the management of BRUEs following the 2016 guideline publication.
• To compare admission rates, testing, revisits, and diagnoses for BRUE/ALTE patients before and after the guideline.

Main Methods:

• Utilized a pediatric multicenter administrative database comparing 2017 (post-guideline) with 2015 (pre-guideline) data.
• Analyzed patients diagnosed with BRUE or apparent life-threatening event (ALTE).
• Employed interrupted time series analysis to evaluate guideline impact on admission rates, stratified by infant age (0-60 and 61-365 days).

Main Results:

• A significant decrease in admission rates was observed: 5.7% for 0-60 day olds and 18.0% for 61-365 day olds from 2015 to 2017.
• Patients in 2017 showed reduced rates of EEG, brain MRI, chest radiography, and laboratory testing compared to 2015.
• Interrupted time series analysis indicated a weekly decrease of 0.2% in admission rates for infants 61-365 days post-guideline publication (P < .001).

Conclusions:

• Post-guideline implementation, patients with BRUE or ALTE experienced lower admission and testing rates.
• These findings suggest the guideline influenced clinical practice, potentially due to revised definitions and recommendations.
• The study highlights the effectiveness of clinical guidelines in modifying healthcare utilization for BRUEs.