What’s Your Diagnosis? BRUE

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got the previous case on Evaluation and Management of Suicidal Ideation and Self-Harm in Children in the Emergency Department right.

Case Presentation: Brief Resolved Unexplained Events: Practical Evaluation and Management in the Emergency Department 

A 3-week-old girl is brought in by EMS after her parents witnessed an episode during which she started coughing and gagging shortly after feeding, then turned blue in the face… 

• After witnessing the episode, her mother began CPR. The parents report that the episode lasted 5 minutes. They tell you the girl is an otherwise healthy baby and was acting well prior to this event. She was born at full term, with no complications during delivery. 
• The baby has normal vital signs and a normal physical examination, including heart, lungs, and neurologic examination. 
• You wonder whether this episode would be considered a BRUE. What testing should be done in the ED, and under what circumstances should the patient be admitted to the hospital? 

Case Conclusion

The girl‘s symptoms would have met the previous criteria for an ALTE, but they did not meet criteria for classification as a BRUE. The event lasted >1 minute and was associated with coughing and gagging after feeding, which suggested a potential identifiable cause for the event. While she met the age criterion (<1 year) as well as the criterion for presence of cyanosis, both the duration of the event (>1 minute, thus not brief) and her associated symptoms (likely due to reflux, thus not unexplained) prevented a diagnosis of a BRUE.

For this reason, the AAP clinical practice guidelines did not apply to this scenario, and you used your best clinical judgment to determine the necessary testing and need for admission. The length of the event, the child’s young age, and the possibility of GER as an inciting factor led you to admit her to the hospital for observation and possible further testing. 

USACS subscribers can log in or renew here.

Last Updated on June 3, 2024