TY - JOUR
T1 - Risk Prediction After a Brief Resolved Unexplained Event
AU - the Brief Resolved Unexplained Event Research and Quality Improvement Network
AU - Nama, Nassr
AU - Hall, Matt
AU - Neuman, Mark
AU - Sullivan, Erin
AU - Bochner, Risa
AU - De Laroche, Amy
AU - Hadvani, Teena
AU - Jain, Shobhit
AU - Katsogridakis, Yiannis
AU - Kim, Edward
AU - Mittal, Manoj
AU - Payson, Alison
AU - Prusakowski, Melanie
AU - Shastri, Nirav
AU - Stephans, Allayne
AU - Westphal, Kathryn
AU - Wilkins, Victoria
AU - Tieder, Joel
N1 - Funding Information:
No funding was secured for this study. Data management and analysis were offered in-kind funding from the Children's Hospital Association. We thank all the members of the BRUE Research and Quality Improvement Network and the MDCalc team for their invaluable contributions.
Publisher Copyright:
Copyright © 2022 by the American Academy of Pediatrics.
PY - 2022/9
Y1 - 2022/9
N2 - OBJECTIVES: Only 4% of brief resolved unexplained events (BRUE) are caused by a serious underlying illness. The American Academy of Pediatrics (AAP) guidelines do not distinguish patients who would benefit from further investigation and hospitalization. We aimed to derive and validate a clinical decision rule for predicting the risk of a serious underlying diagnosis or event recurrence. METHODS: We retrospectively identified infants presenting with a BRUE to 15 children's hospitals (2015-2020). We used logistic regression in a split-sample to derive and validate a risk prediction model. RESULTS: Of 3283 eligible patients, 565 (17.2%) had a serious underlying diagnosis (n = 150) or a recurrent event (n = 469). The AAP's higher-risk criteria were met in 91.5% (n = 3005) and predicted a serious diagnosis with 95.3% sensitivity, 8.6% specificity, and an area under the curve of 0.52 (95% confidence interval [CI]: 0.47-0.57). A derived model based on age, previous events, and abnormal medical history demonstrated an area under the curve of 0.64 (95%CI: 0.59-0.70). In contrast to the AAP criteria, patients >60 days were more likely to have a serious underlying diagnosis (odds ratio:1.43, 95%CI: 1.03-1.98, P = .03). CONCLUSIONS: Most infants presenting with a BRUE do not have a serious underlying pathology requiring prompt diagnosis. We derived 2 models to predict the risk of a serious diagnosis and event recurrence. A decision support tool based on this model may aid clinicians and caregivers in the discussion on the benefit of diagnostic testing and hospitalization (https://www.mdcalc.com/calc/10400/brief-resolved-unexplained-events-2.0-brue-2.0-criteria-infants).
AB - OBJECTIVES: Only 4% of brief resolved unexplained events (BRUE) are caused by a serious underlying illness. The American Academy of Pediatrics (AAP) guidelines do not distinguish patients who would benefit from further investigation and hospitalization. We aimed to derive and validate a clinical decision rule for predicting the risk of a serious underlying diagnosis or event recurrence. METHODS: We retrospectively identified infants presenting with a BRUE to 15 children's hospitals (2015-2020). We used logistic regression in a split-sample to derive and validate a risk prediction model. RESULTS: Of 3283 eligible patients, 565 (17.2%) had a serious underlying diagnosis (n = 150) or a recurrent event (n = 469). The AAP's higher-risk criteria were met in 91.5% (n = 3005) and predicted a serious diagnosis with 95.3% sensitivity, 8.6% specificity, and an area under the curve of 0.52 (95% confidence interval [CI]: 0.47-0.57). A derived model based on age, previous events, and abnormal medical history demonstrated an area under the curve of 0.64 (95%CI: 0.59-0.70). In contrast to the AAP criteria, patients >60 days were more likely to have a serious underlying diagnosis (odds ratio:1.43, 95%CI: 1.03-1.98, P = .03). CONCLUSIONS: Most infants presenting with a BRUE do not have a serious underlying pathology requiring prompt diagnosis. We derived 2 models to predict the risk of a serious diagnosis and event recurrence. A decision support tool based on this model may aid clinicians and caregivers in the discussion on the benefit of diagnostic testing and hospitalization (https://www.mdcalc.com/calc/10400/brief-resolved-unexplained-events-2.0-brue-2.0-criteria-infants).
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U2 - 10.1542/hpeds.2022-006637
DO - 10.1542/hpeds.2022-006637
M3 - Article
C2 - 35965279
AN - SCOPUS:85142272053
SN - 2154-1663
VL - 12
SP - 772
EP - 779
JO - Hospital pediatrics
JF - Hospital pediatrics
IS - 9
ER -