BMJ Paediatrics Open (Sep 2024)

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

  • ,
  • Sanjay Mahant,
  • Nassr Nama,
  • Ronik Kanani,
  • Jessica Foulds,
  • Julie Quet,
  • Anupam Sehgal,
  • Ran D Goldman,
  • Jeffrey N Bone,
  • Peter Gill,
  • Martin Ogwuru,
  • Parnian Hosseini,
  • Zerlyn Lee,
  • Kara Picco,
  • Josée Anne Gagnon,
  • Joanna Holland,
  • Falla Jin,
  • Nardin Kirolos,
  • Susan Akbaroghli,
  • Chris Novak,
  • Brigitte Parisien,
  • Matthew Donlan,
  • Polina Kyrychenko,
  • Ioulia Opotchanova,
  • Émilie Harnois,
  • Alyse Schacter,
  • Elisa Frizon-Peresa,
  • Praveen Rajasegaran,
  • Melody Wyslobicky,
  • Prathiksha Nalan,
  • Joel Tieder,
  • Marie-Pier Goupil,
  • Shawn Lee,
  • Emy Philibert,
  • Juliette Dufresne,
  • Raman Chawla

DOI
https://doi.org/10.1136/bmjpo-2024-002525
Journal volume & issue
Vol. 8, no. 1

Abstract

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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.