Explanatory Diagnoses Following Hospitalization for a Brief Resolved Unexplained Event

• Published in: Pediatrics (Evanston) 2021-11, Vol.148 (5), p.1
• Main Authors: Bochner, Risa, Tieder, Joel S, Sullivan, Erin, Hall, Matt, Stephans, Allayne, Mittal, Manoj K, Singh, Nidhi, Delaney, Atima, Harper, Beth, Shastri, Nirav, Hochreiter, Daniela, Neuman, Mark I
• Format: Article
• Language: English
• Subjects: Brief, Resolved, Unexplained Event - diagnosis; Brief, Resolved, Unexplained Event - epidemiology; Diagnosis; Diagnostic tests; Emergency medical care; Emergency Service, Hospital; Epilepsy; Etiology; Female; Hospitalization; Hospitalization - statistics & numerical data; Humans; Infant; Infant, Newborn; Infants; Male; Medical diagnosis; Patients; Pediatrics; Retrospective Studies; Seizures
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2021-052673

Most young infants presenting to the emergency department (ED) with a brief resolved unexplained event (BRUE) are hospitalized. We sought to determine the rate of explanatory diagnosis after hospitalization for a BRUE. This was a multicenter retrospective cohort study of infants hospitalized with a BRUE after an ED visit between October 1, 2015, and September 30, 2018. We included infants without an explanatory diagnosis at admission. We determined the proportion of patients with an explanatory diagnosis at the time of hospital discharge and whether diagnostic testing, consultation, or observed events occurring during hospitalization were associated with identification of an explanatory diagnosis. Among 980 infants hospitalized after an ED visit for a BRUE without an explanatory diagnosis at admission, 363 (37.0%) had an explanatory diagnosis identified during hospitalization. In 805 (82.1%) infants, diagnostic testing, specialty consultations, and observed events did not contribute to an explanatory diagnosis, and, in 175 (17.9%) infants, they contributed to the explanatory diagnosis (7.0%, 10.0%, and 7.0%, respectively). A total of 15 infants had a serious diagnosis (4.1% of explanatory diagnoses; 1.5% of all infants hospitalized with a BRUE), the most common being seizure and infantile spasms, occurring in 4 patients. Most infants hospitalized with a BRUE did not receive an explanation during the hospitalization, and a majority of diagnoses were benign or self-limited conditions. More research is needed to identify which infants with a BRUE are most likely to benefit from hospitalization for determining the etiology of the event.