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Risk Factors and Outcomes After a Brief Resolved Unexplained Event: A Multicenter Study
Joel S Tieder1, Erin Sullivan2, Allayne Stephans3
1Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital and School of Medicine, University of Washington, Seattle, Washington joel.tieder@seattlechildrens.org.
Pediatrics
|June 25, 2021
Summary
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.
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.
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