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Stanford/Kaiser Emergency Medicine
In May, the American Academy of Pediatrics published new clinical guidelines to replace ALTE (Apparent Life-Threatening Events) with BRUE, Brief Resolved Unexplained Event. The new guidelines, in addition to defining BRUE, offer an approach to evaluation based on risk of repeat event or serious underlying disorder. The goal of the clinical guidelines is to better inform care while reducing costly and unnecessary interventions. The guidelines were devised from a comprehensive literature review of articles related to ALTEs from 1970 to 2014.
BRUE describes an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, now resolved episode with one or more of the following: (1) cyanosis or pallor, (2) absent, decreased or irregular breathing, (3) marked change in tone, and (4) altered level of responsiveness. The diagnosis is made when there is no explanation for a qualifying event after a thorough history and physical exam. BRUE and ALTE definitions differ as BRUE characterizes the event based on physician not caregiver observations and includes an age limit.
