Outcome Prediction of Higher-Risk Brief Resolved Unexplained Events

Abstract

OBJECTIVES: Brief resolved unexplained events (BRUEs) are classified as higher risk on the basis of patient and event characteristics, but there is limited evidence to guide management decisions. The authors of this study aim to describe patients with a higher-risk BRUE, determine the yield of diagnostic evaluation, and explore predictors of clinical outcomes. METHODS: A retrospective medical record review was conducted for patients ≤365 days of age who were evaluated in a tertiary-care pediatric emergency department with a discharge diagnostic code indicative of a BRUE. Demographic and clinical characteristics, including diagnostic evaluation, are reported. Univariate and multivariate analyses were used to test the association of risk factors with clinical outcomes (serious underlying diagnosis, recurrent events, and return hospitalization). RESULTS: Of 3325 patients, 98 (3%) met BRUE criteria and 88 were classified as higher risk; 0.6% of laboratory and 1.5% of ancillary tests were diagnostic, with 4 patients having a serious underlying diagnosis. Nine patients had recurrent events during hospitalization, and 2 were readmitted for a recurrent BRUE after their index visit. Prematurity was the only characteristic significantly associated with an outcome, increasing the odds of a recurrent event (odds ratio = 9.4; P = .02). CONCLUSIONS: The majority of patients with a BRUE are higher risk, but the yield of diagnostic evaluation is low. Published risk criteria do not appear to be associated with adverse clinical outcomes except for prematurity and recurrent events. Future multicentered prospective studies are needed to validate risk stratification and develop management guidance for the higher-risk BRUE population.