3 Categories: High Risk BRUE. Low Risk BRUE. Not a BRUE.

Step 1: Is This a BRUE?

* Brief* <60 seconds* Resolved* Exam and vitals back to baseline in the ED* Unexplained* No symptoms other than event itself* Event* Concerning change in any of the following…* Tone* Color* Breathing* Mental status

Step 2: Is This Low Risk BRUE?

* Five low risk criteria* Age >2 months* Born at >32 weeks gestational age* First and only episode* No CPR by medical providers* No “Red Flags”

Step 3: Do They Have Red Flags?

* For abuse* History of SIDS/BRUE in sibling* Mental illness at home* Drug use at home* For dysrhythmia* Family history of sudden unexplained death* For infection* Fevers* Unimmunized* Sick contacts* Rash

Step 4: Examine for Non-Accidental Trauma

* Bulging fontanelle* Petechia* Torn frenulum* Blood

Step 5: Place Patient Into One of Three Categories

* NOT a BRUE* Treat as you normally would* HIGH risk BRUE* Admit* LOW risk BRUE* Discharge without testing* May consider EKG and pertussis

Additional Reading

* Brief Resolved Unexplained Events (AAP)