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What is the Most Common Cause of Brief Resolved Unexplained Events (BRUEs)?

October 5, 2021

Many infants experience a brief resolved unexplained event (BRUE), defined as a brief “episode of cyanosis or pallor; absent, decreased or irregular breathing; marked change in tone; and/or altered responsiveness” that resolves spontaneously and is not explained after a history and physical examination are completed.

These episodes are frightening for the family and usually result in an emergency department visit and often a hospitalization.

Despite clinical practice guidelines from the American Academy of Pediatrics that stratify BRUEs by risk for serious disease or recurrence, and despite expert consensus on a tiered evaluation approach, there continues to be debate about how much evaluation should be done, and the benefit of hospitalization and extensive evaluation.

Meanwhile, the parents of these infants are concerned that there is something seriously wrong with their infant and frightened that this could happen again. Pediatricians and other medical professionals struggle with their anticipatory guidance for these patients and families.

This week, Pediatrics is early releasing an article by Dr. Rita Bochner at SUNY Downstate and her colleagues in the Brief Resolved Unexplained Event Research and Quality Improvement Network, entitled “Explanatory Diagnoses Following Hospitalization for a Brief Resolved Unexplained Event” (10.1542/peds.2021-052673).

In this study, authors looked at how often a diagnosis that could explain the BRUE was made during the hospitalization. They also looked at how frequently hospitalization and inpatient procedures contributed to making the diagnosis. Finally, they looked at the rate of serious diagnoses, defined as ones for which a delay in diagnosis or treatment could potentially result in increased injury or death.

The authors retrospectively analyzed the records of 980 infants who were hospitalized after a BRUE without an explanatory diagnosis at the time of admission.

The most common diagnosis (63%) was no diagnosis. Of the 37% who were discharged with a diagnosis, the most commonly made diagnoses were gastroesophageal reflux and choking/gagging. Only 4.1% of the diagnoses were classified as serious – including seizures, infantile spasms, severe lower respiratory tract infections, and airway abnormalities.

Take a look at this article – particularly for the details regarding the testing that contributed to diagnoses. However, for the majority of infants, hospitalization is usually unhelpful in determining the cause of BRUEs. This article may provide useful data as you talk with families whose infant has experienced a BRUE and decide whether hospitalization is indicated.

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