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Background: Well appearing infants commonly present with a history of a brief event characterized by changes in color, breathing, muscle tone, or level of alertness. In 1986 the National Institutes of Health coined the term ALTE (Apparent Life-Threatening Event) to describe these events. In 2016 the American Academcy of Pediatrics (AAP) published a guideline that updated the term ALTE to BRUE (Brief Resolved Unexplained Event). This guideline includes a more precise definition and limited recommendations for the evaluation of patients who are designated as lower risk for serious underlying diagnoses. A few small studies have examined the diagnostic yield of specific testing in the BRUE population. There are no large, multi-institutional studies that focus on this research question.

Objective: The primary aim was to determine if specific diagnostic tests done in BRUE patients are linked to a discharge diagnosis or if that diagnosis could have been made by history, physical, and non- invasive monitoring alone. Secondary aim is to report how frequently diagnostic testing takes place.

Design/Methods: Multi institutional, retrospective cohort study of 2036 infants < 1 year of age who presented to 14 children’s hospitals between Oct 1, 2015 and Sep 30, 2018 with an event consistent with the American Academy of Pediatrics (AAP) definition of BRUE. The frequency and contributory rates of diagnostic testing were determined, distinguishing false positive vs true positive findings.

Results: In this cohort 63.2% (1286) patients were hospitalized. The mean age was lower in hospitalized patients 36 days [16,77] vs 72 days [28, 165], 12.8% (262) patients met lower risk AAP criteria, and 45% (923) received an explanation for their event sometime during their ED or inpatient stay. Hospitalized patients and AAP higher risk patients were more likely to undergo more diagnostic testing. A single diagnostic test or consultation contributed to the final diagnoses in 1.89% (132/6951) cases with laboratory testing contributing in 0.9% (36/3605) tests, imaging in 1.8% (45/2408) images, and consults contributing in 5.4% (51/938) consults.

Conclusion(s): Diagnostic testing and consultations contribute to final diagnoses with low overall frequency in patients that present with BRUE. History, physical exam, and non-invasive monitoring remain the most important aspects of initial management. These findings may inform AAP higher risk BRUE evaluation and management guidelines and offer providers a contextual framework for approaching initial evaluation.

Presented at the 2021 PAS Virtual Conference

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Presented at the 2021 PAS Virtual Conference

Utility of Diagnostic Testing in Patients who Present with Brief Resolved Unexplained Event

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