Abstract The American Academy of Pediatrics (AAP) changed the definition ALTE to BRUE in its 2016 guideline, which provides a precise definition and establishes criteria for severity, need for hospitalization, and complementary tests. The objective of this study was to evaluate whether the AAP-guideline implementation reduced complementary tests, hospital stay, and to analyze recurrence rates and risk factors for recurrence. A quasi-experimental study was conducted on patients admitted for ALTE/BRUE between January 2015 and December 2021, before and after the publication of the AAP-guideline. A total of 277 patients admitted for BRUE were included, 84 (30.3%) before the AAP guideline and 193 (69.7%) after. Following the change in definition, a decrease in average hospital stay was observed (3 vs. 2 days, p = 0.03). There were fewer pHmetry tests (28.5% vs. 16.5%, p = 0.03), metabolic tests (13% vs. 4.1%, p < 0.01), and reduced home monitoring (17.9% vs. 8.8%, p = 0.04). We found no differences in income among critical units (0% vs 2.6% p = 0.32). Patients with underlying conditions has a higher risk of recurrence (OR 4.43 (1.14–2.17; p = 0.04)). Conclusions: The implementation of the AAP-guideline in 2016 represents a significant change in the management of this condition, with shorter average hospital stays, fewer supplementary tests, and reduced need for home monitoring, all without compromising patient safety. The number of admissions to critical care units has remained stable, and there has been no increase in recurrences. Patients with underlying conditions are at higher risk of recurrence and constitute a vulnerable group that should be carefully evaluated.<Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is Known: • The AAP redefined ALTE as BRUE in 2016 to standardize diagnosis and guide risk-based management. • Preliminary reports suggest the guideline may have influenced clinical practice, though evidence remains limited and inconsistent. </entry> </row> <row> <entry align="left" colname="c1"> What is New: • This study shows decreased hospital stays, complementary tests, and home monitoring after AAP guideline implementation. • Infants with mild/moderate underlying conditions had higher recurrence risk. </entry> </row> </tbody> </tgroup> </Table>

Impact of the BRUE (Brief Resolved Unexplained event) definition on hospital clinical practice and recurrence: a quasi-experimental study in infants

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2025年6月3日

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Irene Comino-Hidalgo,
María Isabel Gonzalez-Sanchez,
Felipe Gonzalez-Martinez,
Blanca Toledo-del Castillo,
Alicia Fernandez-Gonzalez,
Ana Angulo-Chacon,
Rosa Rodriguez-Fernandez

摘要

Abstract

The American Academy of Pediatrics (AAP) changed the definition ALTE to BRUE in its 2016 guideline, which provides a precise definition and establishes criteria for severity, need for hospitalization, and complementary tests. The objective of this study was to evaluate whether the AAP-guideline implementation reduced complementary tests, hospital stay, and to analyze recurrence rates and risk factors for recurrence. A quasi-experimental study was conducted on patients admitted for ALTE/BRUE between January 2015 and December 2021, before and after the publication of the AAP-guideline. A total of 277 patients admitted for BRUE were included, 84 (30.3%) before the AAP guideline and 193 (69.7%) after. Following the change in definition, a decrease in average hospital stay was observed (3 vs. 2 days, p = 0.03). There were fewer pHmetry tests (28.5% vs. 16.5%, p = 0.03), metabolic tests (13% vs. 4.1%, p < 0.01), and reduced home monitoring (17.9% vs. 8.8%, p = 0.04). We found no differences in income among critical units (0% vs 2.6% p = 0.32). Patients with underlying conditions has a higher risk of recurrence (OR 4.43 (1.14–2.17; p = 0.04)).

Conclusions:

The implementation of the AAP-guideline in 2016 represents a significant change in the management of this condition, with shorter average hospital stays, fewer supplementary tests, and reduced need for home monitoring, all without compromising patient safety. The number of admissions to critical care units has remained stable, and there has been no increase in recurrences. Patients with underlying conditions are at higher risk of recurrence and constitute a vulnerable group that should be carefully evaluated.

What is Known:

• The AAP redefined ALTE as BRUE in 2016 to standardize diagnosis and guide risk-based management.

• Preliminary reports suggest the guideline may have influenced clinical practice, though evidence remains limited and inconsistent.

What is New:

• This study shows decreased hospital stays, complementary tests, and home monitoring after AAP guideline implementation.

• Infants with mild/moderate underlying conditions had higher recurrence risk.