Resource Utilization for Brief Resolved Unexplained Events in a Pediatric and General Emergency Department

The primary aim of this study was to compare resource utilization between lower and higher-risk brief resolved unexplained events (BRUE) in the general (GED) and pediatric (PED) emergency departments.

We conducted a retrospective chart review of BRUE cases from a large health system over 6-and-a-half years. Our primary outcome was the count of diagnostic tests per encounter. Laboratory tests, imaging, and cardiovascular studies were compared between lower and higher-risk BRUE overall and between each category in the GED and PED. Negative binomial regression was used to identify factors associated with increased testing for BRUE, with the count of diagnostic tests as the dependent variable. A priori covariates considered for regression modeling included type of ED, age in days, sex, race, ethnicity, type of insurance, preferred language, and need for interpreter.

Two hundred twenty of the 373 (59%) cases identified by administrative review were clinical BRUE cases based on chart review. Twenty (9%) were lower-risk and 200 (91%) higher-risk. Overall, more tests were performed in higher-risk BRUE than lower-risk BRUE [median: 2 (interquartile range-IQR: 1 to 5.75) vs. median: 1 (IQR: 0 to 2), P =0.01]. There was no difference in the number of tests performed in lower-risk BRUE in the GED and PED. Fewer tests were performed in higher-risk BRUE in the GED [median: 1 (IQR: 0 to 2) vs. median: 3 (IQR: 1 to 6), P <0.001]. Ninety-one percent of BRUE from GED and 85% from PED were admitted or transferred ( P =0.37). In the regression model, only the type of ED [PED as reference; β: -0.925 (95% CI: -1.263 to -0.586), P <0.001] remained significant.

Fewer tests were performed for higher-risk BRUE in the GED compared with the PED; however, a majority of all BRUE are admitted or transferred. This finding suggests there are potential opportunities for decreasing variation in BRUE testing and management.