Identifying serious underlying diagnoses among patients with brief resolved unexplained events (BRUEs): a Canadian cohort study

• Main Authors: Sanjay Mahant (Author), Nassr Nama (Author), Ronik Kanani (Author), Jessica Foulds (Author), Julie Quet (Author), Anupam Sehgal (Author), Ran D Goldman (Author), Jeffrey N Bone (Author), Peter Gill (Author), Martin Ogwuru (Author), Parnian Hosseini (Author), Zerlyn Lee (Author), Kara Picco (Author), Josée Anne Gagnon (Author), Joanna Holland (Author), Falla Jin (Author), Nardin Kirolos (Author), Susan Akbaroghli (Author), Chris Novak (Author), Brigitte Parisien (Author), Matthew Donlan (Author), Polina Kyrychenko (Author), Ioulia Opotchanova (Author), Émilie Harnois (Author), Alyse Schacter (Author), Elisa Frizon-Peresa (Author), Praveen Rajasegaran (Author), Melody Wyslobicky (Author), Prathiksha Nalan (Author), Joel Tieder (Author), Marie-Pier Goupil (Author), Shawn Lee (Author), Emy Philibert (Author), Juliette Dufresne (Author), Raman Chawla (Author)
• Format: Book
• Published: BMJ Publishing Group, 2024-09-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Objective To describe the demographics and clinical outcomes of infants with brief resolved unexplained events (BRUE).Design A retrospective cohort study.Setting 11 centres within the Canadian Paediatric Inpatient Research Network.Patients Patients presenting to the emergency department (ED) following a BRUE (2017-2021) were eligible, when no clinical cause identified after a thorough history and physical examination.Main outcome measures Serious underlying diagnosis (requiring prompt identification) and event recurrence (within 90 days).Results Of 1042 eligible patients, 665 were hospitalised (63.8%), with a median stay of 1.73 days. Diagnostic tests were performed on 855 patients (82.1%), and 440 (42.2%) received specialist consultations. In total, 977 patients (93.8%) were categorised as higher risk BRUE per the American Academy of Pediatrics guidelines. Most patients (n=551, 52.9%) lacked an explanatory diagnosis; however, serious underlying diagnoses were identified in 7.6% (n=79). Epilepsy/infantile spasms were the most common serious underlying diagnoses (2.0%, n=21). Gastro-oesophageal reflux was the most common non-serious underlying diagnosis identified in 268 otherwise healthy and thriving infants (25.7%). No instances of invasive bacterial infections, arrhythmias or metabolic disorders were found. Recurrent events were observed in 113 patients (10.8%) during the index visit, and 65 patients had a return to ED visit related to a recurrent event (6.2%). One death occurred within 90 days.Conclusions There is a low risk for a serious underlying diagnosis, where the majority of patients remain without a clear explanation. This study provides evidence-based risk for adverse outcomes, critical information to be used when engaging in shared decision-making with caregivers.

Item Description

10.1136/bmjpo-2024-002525
2399-9772