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. 2025 Jun 26.
doi: 10.1002/jhm.70094. Online ahead of print.

Interhospital variation in the management of Brief Resolved Unexplained Events (BRUE) in infants: A Canadian multicenter cohort study

Nassr Nama  1 , Kara Picco  2 , Polina Kyrychenko  2 , Jeffrey N Bone  3 , Julie Quet  4 , Jessica L Foulds  5 , Josée Anne Gagnon  6 , Chris Novak  7 , Brigitte Parisien  8 , Matthew Donlan  9 , Ran D Goldman  10 , Anupam Sehgal  11 , Ronik Kanani  12 , Joanna Holland  13 , Sanjay Mahant  2 , Eric Coon  1 , Joel S Tieder  1 , Peter J Gill  2 ; Canadian BRUE Collaboration (C‐BRUE‐C) and the Canadian Paediatric Inpatient Research Network (PIRN)
Affiliations

Interhospital variation in the management of Brief Resolved Unexplained Events (BRUE) in infants: A Canadian multicenter cohort study

Nassr Nama et al. J Hosp Med. .

Abstract

Background: Guidelines on Brief Resolved Unexplained Event (BRUE) only provide recommendations for infants categorized at lower risk. However, most infants fall into the higher-risk category, leaving management decisions to individual clinicians and contributing to variation in care.

Objectives: Describe interhospital variation in BRUE management and determine whether higher resource utilization improves detection of serious underlying diagnoses.

Methods: This multicenter observational cohort (2017-2021) included infants (< 12 months) with BRUE at eight Canadian hospitals. We recorded admission, and use of electrocardiograms (ECG), electroencephalograms (EEG), antibiotic and anti-reflux medications, and subspecialty consultations. Multivariable median regression evaluated the association between tests/interventions and length of stay (LOS), and logistic regression assessed whether site-level resource use correlated with serious underlying diagnoses detection.

Results: Of 758 infants (92% higher-risk), we noted variation in admission rates (32%-76%, p < .001), ICU admissions (0%-20%, p < .001), median LOS (0.8-2.0 days, p < .001), ECG (24%-78%, p < .001), EEG (8%-29%, p = .001), and anti-reflux medication (0%-21%, p < .001). Five percent had a serious underlying diagnosis, with no significant site differences (0%-8%, p = .49). Median regression showed EEG (19.9 h, 95% CI: 6.8-33.0, p = .03), empiric antibiotics (15.8 h, 95% CI: 4.7-26.9, p = .03), and subspecialty consultation (17.0 h, 95% CI: 10.8-23.2, p < .001) were associated with longer LOS. Higher resource use did not increase detection of serious underlying diagnoses.

Conclusions: Substantial variation exists in BRUE management, associated with prolonged LOS. Higher admission and testing were not associated with increased detection of serious underlying diagnoses. These findings highlight the need for standardized care approaches.

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References

REFERENCES

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