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Impact of the AAP Guideline on Management of Brief Resolved Unexplained Events

Kamakshya P Patra1, Matthew Hall2, Amy M DeLaroche3

  • 1West Virginia University Medicine Children's Hospital, Morgantown, West Virginia.

Hospital Pediatrics
|August 14, 2022
PubMed

Insights

The American Academy of Pediatrics guideline for brief resolved unexplained events (BRUEs) reduced hospital admissions, testing, and costs. This clinical practice guideline improved patient care without increasing revisit rates.

Area of Science:

  • Pediatric emergency medicine
  • Clinical practice guidelines
  • Health services research

Background:

  • The American Academy of Pediatrics (AAP) updated guidelines in May 2016, redefining apparent life-threatening events (ALTEs) as brief resolved unexplained events (BRUEs).
  • The guideline recommended a risk-based management approach for BRUEs.

Purpose of the Study:

  • To analyze the impact of the AAP's clinical practice guideline (CPG) publication on patient management for BRUEs.
  • To assess changes in admission rates, diagnostic testing, treatment, cost, length of stay (LOS), and revisit rates post-guideline implementation.

Main Methods:

  • Utilized the Pediatric Health Information Systems database for patient encounters with ALTE/BRUE diagnoses from January 2012 to December 2019.
  • Compared pre-guideline (Jan 2012-Jan 2016) and post-guideline (Jul 2016-Dec 2019) cohorts using interrupted time series analysis.

Main Results:

  • A significant reduction in 12 discouraged diagnostic tests was observed.
  • Hospital admissions decreased by 13.7%, medication utilization by 8.3%, cost by $1146.8, and LOS by 0.2 days.
  • Electrocardiogram use increased by 3.5%, aligning with guideline recommendations, while revisit rates remained unchanged.

Conclusions:

  • The AAP BRUE clinical practice guideline was associated with significant reductions in diagnostic testing, medication use, hospital admissions, costs, and LOS.
  • The guideline implementation led to an estimated 2678 avoided admissions.
  • Patient management for BRUEs became more efficient and cost-effective without compromising follow-up care.
Abstract

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