Related Experiment Video
Updated: Aug 20, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Diagnostic testing for and detection of physical abuse in infants with brief resolved unexplained events
Angela Doswell1, James Anderst2, Joel S Tieder3
1Division of Child Abuse and Neglect, Department of Pediatrics, Connecticut Children's Medical Center and University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT 06106, United States of America.
Insights
Brief Resolved Unexplained Events (BRUE) in infants may indicate physical abuse. Diagnostic testing rates for abuse were low, with few cases identified, suggesting a need for standardized protocols.
Area of Science:
- Pediatric Emergency Medicine
- Child Abuse Pediatrics
- Neonatal Care
Background:
- A Brief Resolved Unexplained Event (BRUE) can be an indicator of underlying physical abuse in infants.
- Early identification of physical abuse is critical for infant well-being.
Purpose of the Study:
- To determine the frequency of diagnostic tests for physical abuse (head imaging, skeletal survey, liver transaminases) during a BRUE presentation.
- To estimate the incidence of diagnosed physical abuse in infants up to one year of age following a BRUE.
Main Methods:
- A multicenter retrospective cohort study of 2036 infants presenting with BRUE across 15 hospitals.
- Generalized estimating equations were used to analyze associations with diagnostic testing rates.
Main Results:
- Low rates of diagnostic testing were observed: 6.2% for head imaging, 7.0% for skeletal survey, and 12.1% for liver transaminases.
- Physical abuse was diagnosed in only 7 infants (0.3%), with most diagnoses occurring over 30 days after the initial BRUE presentation.
- Skeletal surveys were more likely with concerning physical exam findings or social history.
Conclusions:
- Diagnostic testing for physical abuse in infants with BRUE is infrequent.
- The low identification rate highlights the need for further research and standardized testing protocols to detect occult physical abuse in this population.
Background:
A Brief Resolved Unexplained Event (BRUE) can be a sign of occult physical abuse.
Objectives:
To identify rates of diagnostic testing able to detect physical abuse (head imaging, skeletal survey, and liver transaminases) at BRUE presentation. The secondary objective was to estimate the rate of physical abuse diagnosed at initial BRUE presentation through 1 year of age.
Participants And Setting:
Infants who presented with a BRUE at one of 15 academic or community hospitals were followed from initial BRUE presentation until 1 year of age for BRUE recurrence or revisits.
Methods:
This study was part of the BRUE Research and Quality Improvement Network, a multicenter retrospective cohort examining infants with BRUE. Generalized estimating equations assessed associations with performance of diagnostic testing (adjusted odds ratio (aOR)).
Results:
Of the 2036 infants presenting with a BRUE, 6.2 % underwent head imaging, 7.0 % skeletal survey, and 12.1 % liver transaminases. Infants were more likely to undergo skeletal survey if there were physical examination findings concerning for trauma (aOR 8.23, 95 % CI [1.92, 35.24], p < 0.005) or concerning social history (aOR 1.89, 95 % CI [1.13, 3.16], p = 0.015). There were 7 (0.3 %) infants diagnosed with physical abuse: one at BRUE presentation, one <3 days after BRUE presentation, and five >30 days after BRUE presentation.
Conclusion:
There were low rates of diagnostic testing and physical abuse identified in infants presenting with BRUE. Further study including standardized testing protocols is warranted to identify physical abuse in infants presenting with a BRUE.
