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    Updated guideline for “brief resolved unexplained events”

    A recently published 2016 guideline by the American Academy of Pediatrics (AAP) recommends replacing “apparent life-threatening event” or ALTE with the more accurate term “brief resolved unexplained event” or BRUE.

    “The new name better reflects the transient nature and lack of clear cause for all events,” said Joel Tieder, MD, MPH, FAAP, associate professor of Pediatrics, Division of Hospital Medicine, Seattle Children’s Hospital and the University of Washington, Seattle, in his presentation “Management of brief resolved unexplained events: Rethinking ALTE” on Monday, October 24.

    Tieder provided information on the new definition and recommendations in the guideline to help pediatricians implement them into their ambulatory or hospital practice.

    A BRUE is an event occurring in an infant aged younger than 1 year that is characterized by a sudden, brief, and now resolved episode that includes one of the following: cyanosis or pallor; absent, decreased, or irregular breathing; marked change of tone; or altered level of responsiveness. Tieder emphasized that these events are not precursors to sudden infant death syndrome (SIDS).

    The guideline, said Tieder, recommends categorizing infants who exhibit these symptoms into lower-risk or higher-risk groups. For lower-risk infants, the guideline recommends no testing or intervention.

    “Unlike most guidelines, this one focuses more on what NOT to do,” said Tieder. In the past, he explained, infants with an apparent life-threatening event could be hospitalized and given multiple diagnostic tests. These tests all carried their own risks and increased parents’ anxiety, without necessarily leading to a treatable diagnosis or a way to prevent future events.

    “This new guideline helps doctors determine which infants do not need hospitalization or further tests because they are at low risk for another event or a serious underlying diagnosis,” he said, adding that this allows physicians to reassure parents.

    Tieder described an implementation tool kit available to physicians to help them apply the new guideline recommendations to their practice. The tool kit includes an algorithm, quality measures, a caregiver handout, and a key driver diagram. Tieder provided physicians with information on where to find the implementation materials.

    Overall, Tieder emphasized the twin goals of the guideline. “As much as the guideline aims to improve the health of infants by more accurately classifying their risk and reducing their exposure to unnecessary tests and treatments, it will also improve the health of families by not subjecting them to additional fear and anxiety,” he said.


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