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Risk Factors and Outcomes After a Brief Resolved Unexplained Event: A Multicenter Study.

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The American Academy of Pediatrics (AAP) risk criteria for brief resolved unexplained events (BRUEs) accurately identify low-risk infants but often misclassify many as higher-risk, potentially due to factors like age not correlating with outcomes.

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Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Risk Assessment
  • Infant Health Outcomes

Background:

  • Brief Resolved Unexplained Events (BRUEs) are common in infants.
  • The accuracy of American Academy of Pediatrics (AAP) risk criteria for BRUEs is not well-established.
  • Predicting BRUE outcomes using AAP criteria requires further evaluation.

Purpose of the Study:

  • To assess the predictive accuracy of AAP risk criteria for BRUE outcomes.
  • To determine if event characteristics influence BRUE outcomes.
  • To evaluate the risk for recurrence, revisits, and serious diagnoses in infants with BRUEs.

Main Methods:

  • Retrospective cohort study of infants (<1 year) with BRUEs.
  • Inclusion of data from 15 pediatric and community hospitals.
  • Multivariable regression analysis to associate AAP risk factors and event characteristics with outcomes.

Main Results:

  • 87% of 2036 infants had at least one AAP higher-risk factor.
  • Revisits occurred in 6.9% (ED) and 10.7% (hospital) of discharges.
  • Serious diagnoses (e.g., seizures, airway abnormalities) were identified in 4.0% of cases, with 45% found after the initial visit.

Conclusions:

  • AAP BRUE risk criteria effectively identify low-risk patients but frequently over-identify higher-risk patients.
  • Certain factors like event duration, abnormal history, and altered responsiveness increase the risk of serious diagnoses.
  • Some AAP risk factors, like age, may not be associated with BRUE outcomes.