147 Brief resolved unexplained event (BRUE) – how are we managing in the West Midlands?

• Published in: Archives of disease in childhood 2023-07, Vol.108 (Suppl 2), p.A104-A105
• Main Authors: Warner, Rebecca, Singh, Anandi, Maduemem, Kene, Simpson, Joseph, Alaa El Tayeb, Scrimshaw, Lucy, Semeicem, Mohamed, Dixon, Zahraa, Tan, Khai, Ezeh, Nonye, Khairul Ain Binti Kamarudin, Lemaire, Louisa, Quaynor, Josephine, Thompson, Jayne, Akpofure, Patrick, Walker, Kylee, Meenan, Sarah, Hotchkiss, Rachel, Jyothish, Deepthi, Debelle, Geoff
• Format: Article
• Language: English
• Subjects: Audits; Diagnosis; Emergency medical care; Gastroesophageal reflux; Guidelines; Hospitals; Infants; Patients; Pediatrics; Risk groups; Young Children
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.176

ObjectivesAmerican Academy of Pediatrics (AAP) guidelines (2016)1 redefined ALTE (Acute Life Threatening Event) as BRUE (Brief Resolved Unexplained Event), with separate management pathways2 for high-risk and low-risk categories of patients. Although the term BRUE is used in the UK, there is no national BRUE guideline. The Partners in Paediatrics (PiP) handbook (2022–24 edition)3 includes a BRUE guideline aligned with AAP recommendations, which can be accessed by hospitals in West Midlands. Our aim was to audit the management of BRUE across seven hospitals in West Midlands.MethodsA prospective audit was undertaken by PRAM (Paediatric Research Across the Midlands), from May to July 2022, on the initial management of patients with suspected BRUE, attending the emergency department or paediatric assessment unit at seven West Midlands hospitals. The PiP BRUE guideline was used as audit standard: all low risk patients should be discharged without further investigations; all high risk patients should be admitted for minimum of 24 hours observations, have all first-line investigations completed, and Tier 2 or consultant review before discharge.Results63 patients were included, 20 (31%) were of age 61 days to 6 months and 35 (55% ) were male. 53 (84%) met the high-risk criteria (figure 1). None of the high-risk category patients received the complete set of recommended first-line investigations. 100% of low-risk patients underwent further investigations and were observed for more than 4 hours (Figure 2). Of the high-risk category patients, 52 (98%) were seen by a Tier 2 professional or consultant and 20 (38%) were observed for at least 24 hours prior to discharge. 33 (52%) patients had a discharge diagnosis of BRUE. 11 (17%) had acute respiratory illness and 7 (11%) had gastroesophageal reflux as discharge diagnosis.ConclusionOur audit shows variable adherence to the regional PiP BRUE guideline. One participating hospital had a local BRUE guideline, while the other six hospitals did not have a local BRUE guideline or clear signposting to PiP guidelines. We recommend that there should be increased awareness and implementation of established BRUE management guidelines in paediatric units, to ensure standardised care for patients. It also prompts the observation that there have been no studies validating the AAP BRUE guideline in the UK population. Further work should be undertaken to evaluate the performance of the AAP BRUE guideline in the UK, to determine the need