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Management of Infants with Brief Resolved Unexplained Events (BRUE) and Apparent Life-Threatening Events (ALTE): A

Giovanni Prezioso1, Serafina Perrone2, Giacomo Biasucci3

  • 1Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy.

Life (Basel, Switzerland)
|March 6, 2021
PubMed

Insights

Brief Resolved Unexplained Events (BRUE) and Apparent Life-Threatening Events (ALTE) management is debated. Expert consensus using the RAND/UCLA method informed a shared protocol to guide pediatricians, reducing unnecessary tests and hospitalizations.

Area of Science:

  • Pediatrics
  • Emergency Medicine
  • Clinical Protocol Development

Background:

  • Infant events involving changes in breath, tone, and skin color cause caregiver distress.
  • Management of brief resolved unexplained events (BRUE) and apparent life-threatening events (ALTE) remains a subject of debate.
  • A need exists for standardized protocols in the prevention and hospital management of BRUE/ALTE.

Purpose of the Study:

  • To survey current trends in BRUE/ALTE prevention, decision-making, and management.
  • To develop a shared protocol for hospitals and primary care pediatricians.
  • To establish consensus on hospital admission criteria, work-up, and post-discharge monitoring for BRUE/ALTE patients.

Main Methods:

  • A panel of 54 experts was convened to achieve consensus using the RAND/UCLA appropriateness method.
  • Twelve scenarios were developed, covering primary prevention and hospital management of BRUE/ALTE.
  • Experts ranked management options for each scenario on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate).

Main Results:

  • The expert panel reached several points of agreement but also identified areas of disagreement and the need for focused education.
  • Combining existing recommendations with expert opinions facilitated informed decision-making.
  • The RAND/UCLA method helped guide pediatricians toward reasoned evaluations, treatments, and follow-ups for infants with BRUE/ALTE.

Conclusions:

  • The developed protocol aims to reduce inappropriate diagnostic exams and hospitalizations for BRUE/ALTE.
  • The study highlights priorities for educational interventions for healthcare providers.
  • This consensus-driven approach supports evidence-based and expert-informed management of BRUE/ALTE in infants.

Keywords:
ALTEBRUERAND/UCLA appropriateness methodSIDSpediatric emergency

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