Diagnostic Evaluation Low Yield for Patients with a Lower-Risk Brief Resolved Unexplained Event

Rita Haddad; Sarah Parker; Ahmad Farooqi; Amy M DeLaroche

doi:10.1177/2333794X20967586

Diagnostic Evaluation Low Yield for Patients with a Lower-Risk Brief Resolved Unexplained Event

Glob Pediatr Health. 2021 Feb 1:8:2333794X20967586. doi: 10.1177/2333794X20967586. eCollection 2021.

Authors

Rita Haddad¹, Sarah Parker², Ahmad Farooqi², Amy M DeLaroche¹

Affiliations

¹ Children's Hospital of Michigan, Detroit, MI, USA.
² Wayne State University, Detroit, MI, USA.

Abstract

In contrast to patients with an apparent life-threatening event (ALTE), the American Academy of Pediatrics recommends very limited evaluation for patients categorized as lower-risk brief resolved unexplained event (BRUE). This retrospective review aims to explore potential missed diagnostic opportunities for patients with a lower-risk BRUE (n = 10) through comparison with a subset of patients with ALTE (n = 72). None of the patients with a lower-risk BRUE had laboratory, imaging or ancillary studies that were diagnostic. Among patients with ALTE, 5 had laboratory and 3 had imaging studies that were diagnostic. None of the patients with a lower-risk BRUE had recurrent events during hospitalization or a serious underlying diagnosis identified within the 90 day follow-up period. As recommended by the AAP, patients with a lower-risk BRUE do not need diagnostic evaluation and can be discharged home with outpatient follow-up.

Keywords: apparent life-threatening event (ALTE); diagnostic evaluation; emergency department (ED); lower-risk brief resolved unexplained event (BRUE); outcomes.