Abstract
Unexpected events of breath, tone, and skin color change in infants are a cause of considerable distress to the caregiver and there is still debate on their appropriate management. The aim of this study is to survey the trend in prevention, decision-making, and management of brief resolved unexplained events (BRUE)/apparent life-threatening events (ALTE) and to develop a shared protocol among hospitals and primary care pediatricians regarding hospital admission criteria, work-up and post-discharge monitoring of patients with BRUE/ALTE. For the study purpose, a panel of 54 experts was selected to achieve consensus using the RAND/UCLA appropriateness method. Twelve scenarios were developed: one addressed to primary prevention of ALTE and BRUE, and 11 focused on hospital management of BRUE and ALTE. For each scenario, participants were asked to rank each option from ‘1’ (extremely inappropriate) to ‘9’ (extremely appropriate). Results derived from panel meeting and discussion showed several points of agreement but also disagreement with different opinion emerged and the need of focused education on some areas. However, by combining previous recommendations with expert opinion, the application of the RAND/UCLA appropriateness permitted us to drive pediatricians to reasoned and informed decisions in term of evaluation, treatment and follow-up of infants with BRUE/ALTE, reducing inappropriate exams and hospitalisation and highlighting priorities for educational interventions.
Highlights
Unexpected events of breath, tone, and skin color change in infants are a cause of considerable distress to the caregiver, often pushed to seek emergency medical care
The Research and Development Corporation (RAND)/University of California – Los Angeles (UCLA) method can be considered a variant of the Delphi technique, as it involves a group of experts/specialists reading a detailed literature review, answering anonymously to a questionnaire, followed by an open discussion of the survey and by a possible second round questionnaire to minimize possible disagreements [7]
Scenario 1—Prevention of apparent life-threatening events (ALTE)/brief resolved unexplained events (BRUE) The panel considered eight indications addressed to primary prevention of ALTE/BRUE
Summary
Unexpected events of breath, tone, and skin color change in infants are a cause of considerable distress to the caregiver, often pushed to seek emergency medical care. In 2016, the American Academy of Pediatrics (AAP) Sub-Committee on Apparent Life Threatening Events proposed to define as “brief resolved unexplained events” (BRUE) any brief, transient, resolved events in children less than 12 months of age with no explainable cause after careful medical examination [2]. The intent was both to leave the clinician the characterization of the episode and to reduce the caregiver’s perception of severity. The Italian Committee focused on diagnostic work-up, hospital management and clinical follow-up of ALTE, providing a valid support for physicians, who routinely deal with this emerging condition [3]
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