Application of the BRUE Definition and Risk Stratification on an ALTE Population: a European Essay

Abstract

Recent adapted guidelines on the approach of apparent life-threatening events (ALTE) propose a new definition of the phenomenon: brief resolved unexplained events (BRUE) and a risk stratification aimed at reducing unnecessary and expensive medical procedures. We applied the BRUE directives to a series of ALTE patients which required the intervention of the emergency medical service (ES) and/or the emergency department (ED) and were addressed to the Reference Center for Paediatric Sleep Medicine and Sudden Infant Death Syndrome in the Piedmont region between 2009 and 2015 to identify the number of BRUE cases and to classify them as lower or higher risk. We performed a retrospective file review. ALTE patients < 1 year admitted to a ES or ED were considered eligible; the American Academy of Pediatrics (AAP) Guidelines were used to identify BRUEs and to stratify them in lower and higher risk categories. A total of 790 ALTEs were eligible, 164/790 met the BRUE criteria; 62/164 were considered lower risk BRUE, according to their demographic features. Only few ALTEs matched the BRUE criteria in our study population (about 1/5). It was observed that demographic characteristics strongly influenced stratification to lower risk BRUE (8% of the initial sample group). Our data confirm that the AAP guidelines can be useful in the management of BRUE, but especially in the hands of well-trained and experienced physicians in this field.