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Emergency medicine updates: Pediatric brief resolved unexplained event
Brit Long1, Anna M DePompolo2, Michael Gottlieb3
1Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA.
Insights
Brief Resolved Unexplained Events (BRUEs) in infants are often benign but can lead to unnecessary evaluations. Understanding current evidence helps emergency clinicians risk-stratify low-risk cases, improving care and reducing healthcare costs.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pediatrics
- Evidence-Based Medicine
Background:
- Brief Resolved Unexplained Events (BRUEs) affect many infants, often with benign causes.
- Low-risk BRUE cases frequently undergo unnecessary evaluations and admissions.
- Awareness of current BRUE evidence is critical for emergency department (ED) clinicians.
Purpose of the Study:
- To evaluate key evidence-based updates on pediatric BRUE.
- To provide guidance for emergency clinicians managing BRUE.
Main Methods:
- Literature review of current evidence on BRUE.
- Analysis of diagnostic criteria and risk-stratification approaches.
- Focus on emergency department encounters.
Main Results:
- BRUE definition: sudden, brief (<1 min) resolved episode in infants <1 year with changes in breathing, tone, consciousness, or color.
- BRUEs cause significant caregiver and clinician distress.
- Risk-stratification and shared decision-making are essential.
Conclusions:
- Identifying low-risk BRUE events minimizes unnecessary testing.
- Appropriate evaluation for non-low-risk cases is crucial.
- Understanding current BRUE literature improves emergency care for pediatric patients.
Introduction:
Brief resolved unexplained events (BRUEs) can occur in a large number of pediatric patients, with most having a benign etiology. However, in many cases, these can result in unnecessary evaluations and admissions among low-risk patients. Therefore, it is critical for clinicians to be aware of the current evidence regarding BRUE in the emergency department (ED) setting.
Objective:
This paper evaluates key evidence-based updates concerning pediatric BRUE for the emergency clinician.
Discussion:
A BRUE is defined as a clinical entity occurring in an infant less than 1 year of age that an observer reports as sudden, brief (< 1 min), and now resolved episode with no explanation and accompanied by at least one of the following: Change in breathing, pallor or cyanosis, change in tone, or altered level of consciousness. BRUEs often cause significant distress for both caregivers and medical professionals. Having an approach to risk-stratification and engaging in shared decision-making with caregivers can help guide clinicians during these encounters. Clearly identifying what qualifies as a low-risk event can minimize unnecessary testing while ensuring that children who do not meet low-risk criteria receive an appropriately focused evaluation CONCLUSION: An understanding of the current literature concerning BRUE can assist emergency clinicians and improve the care of these patients.
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