Educational Pearls:

• BRUE (Brief Resolved Unexplained Event) replaces what was previously called ALTE

• BRUE describes an event in a child less than one year of age with one or more of the following:
  • cyanosis or pallor
  • absent, decreased, or irregular breathing
  • decreased or increased tone
  • altered responsiveness

• These must be sudden, brief, and now resolved and without an alternative explanation after a history and physical exam

• Low risk patients can be safely discharged with reassurance

• Low risk criteria must all be present:
  • Age over 60 days old
  • >32 weeks gestational age at birth and adjusted gestational age > 45 weeks)
  • No CPR was performed (by a trained medical professional)
  • First event
  • Duration less than 1 minute of event

• Patients who satisfy above criteria can be considered low risk and may be discharged after minimal/no workup

References:

Tieder JS, Bonkowsky JL, Etzel RA, et al. Clinical Practice Guideline: Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants: Executive Summary. Pediatrics. 2016:137(5):e20160591. Pediatrics. 2016 Aug;138(2). pii: e20161488. doi: 10.1542/peds.2016-1488. PubMed PMID: 27474017.

Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD