Specialty Consultations and Diagnostic Testing Accuracy After Brief Resolved Unexplained Events: A Multicenter...

Area of Science:

• Pediatrics
• Neonatology
• Emergency Medicine

Background:

• Current guidelines for Brief Resolved Unexplained Events (BRUE) primarily address lower-risk infants, leaving management for the majority undefined.
• This study evaluates diagnostic strategies for all infants presenting with BRUE, not just those deemed low-risk.

Purpose of the Study:

• To assess the diagnostic yield and accuracy of various tests and subspecialist consultations in infants with BRUE.
• To inform evidence-based management strategies for a broader spectrum of BRUE cases.

Main Methods:

• A retrospective cohort study of 1042 infants with BRUE across 11 Canadian hospitals (2017-2021).
• Review of medical records within 90 days of the index visit to identify diagnostic testing and newly diagnosed underlying conditions.
• Evaluation of diagnostic accuracy by comparing test results against confirmed or probable diagnoses.

Main Results:

• Of 855 infants tested, only 8.4% received explanatory diagnoses, while 64.8% had nonsignificant findings.
• Complete blood counts and electrocardiograms showed low sensitivity and specificity for common indications.
• Electroencephalograms demonstrated higher sensitivity and specificity, but tests like liver enzymes, ammonia, and blood cultures yielded no diagnoses.
• Four laboratory tests had false positive rates exceeding 50%: blood gas, inborn errors of metabolism testing, electrolytes, and bilirubin.
• Consultations identified explanatory diagnoses in 27.7% and incidental findings in 15.9% of patients.

Conclusions:

• Diagnostic testing and consultations for BRUE are frequently utilized but infrequently yield significant diagnoses.
• Many tests exhibit low accuracy and high false positive rates, questioning their routine application.
• Routine diagnostic approaches for BRUE should be reconsidered unless specific clinical indications are present.