Identifying serious underlying diagnoses among patients with brief resolved unexplained events (BRUEs): a Canadian cohort study.
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Nama Nassr, Lee Zerlyn, Picco Kara, Jin Falla, Bone Jeffrey N, Quet Julie, Foulds Jessica, Gagnon Josée Anne, Novak Chris, Parisien Brigitte, Donlan Matthew, Goldman Ran D, Sehgal Anupam, Kanani Ronik, Holland Joanna, Kyrychenko Polina, Kirolos Nardin, Opotchanova Ioulia, Harnois Émilie, Schacter Alyse, Frizon-Peresa Elisa, Rajasegaran Praveen, Hosseini Parnian, Wyslobicky Melody, Akbaroghli Susan, Nalan Prathiksha, Mahant Sanjay, Tieder Joel, Gill Peter, Canadian BRUE Collaboration (C-BRUE-C) and the Canadian Paediatric Inpatient Research Network (PIRN)
Аннотация
DESIGN: A retrospective cohort study.
SETTING: 11 centres within the Canadian Paediatric Inpatient Research Network.
PATIENTS: Patients presenting to the emergency department (ED) following a BRUE (2017-2021) were eligible, when no clinical cause identified after a thorough history and physical examination.
MAIN OUTCOME MEASURES: Serious underlying diagnosis (requiring prompt identification) and event recurrence (within 90 days).
RESULTS: Of 1042 eligible patients, 665 were hospitalised (63.8%), with a median stay of 1.73 days. Diagnostic tests were performed on 855 patients (82.1%), and 440 (42.2%) received specialist consultations. In total, 977 patients (93.8%) were categorised as higher risk BRUE per the American Academy of Pediatrics guidelines. Most patients (n=551, 52.9%) lacked an explanatory diagnosis; however, serious underlying diagnoses were identified in 7.6% (n=79). Epilepsy/infantile spasms were the most common serious underlying diagnoses (2.0%, n=21). Gastro-oesophageal reflux was the most common non-serious underlying diagnosis identified in 268 otherwise healthy and thriving infants (25.7%). No instances of invasive bacterial infections, arrhythmias or metabolic disorders were found. Recurrent events were observed in 113 patients (10.8%) during the index visit, and 65 patients had a return to ED visit related to a recurrent event (6.2%). One death occurred within 90 days.
CONCLUSIONS: There is a low risk for a serious underlying diagnosis, where the majority of patients remain without a clear explanation. This study provides evidence-based risk for adverse outcomes, critical information to be used when engaging in shared decision-making with caregivers.