# 244 Is Trouble BRUEing?
There is nothing more frightening to a caring parent than the sudden helpless fear that the infant suddenly died or is dying. If moments later, the child seems recovered: "What was that? Is it going to happen again? What should I do? Could he die?" Finding good answers puts us on the spot. Historically, increased awareness of 'Cot Deaths' led to the term Sudden Infant Death Syndrome. Babies who had strange spells colloquially were thought to be "Near- SIDS." To lessen confusion, the term became ALTE (Apparent Life-Threatening Event). For clearer definition and guidelines, the AAP replaced it with BRUE (Brief Resolved Unexplained Event) "intended to better reflect the transient nature and lack of clear cause and removes the 'life-threatening' label."Tieder, q.v.
The value of the new definition and the evidence for it is as a RISK STRATIFICATION TOOL to determine which child is Low-Risk who may, after history and physical, some observation and monitoring, be safely discharged. It is a diagnosis of exclusion; outliers will be at higher-risk requiring further focused evaluation. It is a springboard for discussion with parents of an otherwise healthy child as to risks/perils of extensive/expensive work-up which evidence suggests is unlikely to be fruitful. The parent is a sensitive monitor, of greater benefit, and should further help be needed —it is available. Sensitive and practical suggestions may be included (first aid and CPR training) in a general sense to give confidence and immediate rescue, which nonetheless does not suggest an imminent crisis.
Tieder, J. S., Bonkowsky, J. L., Etzel, R. A., Franklin, W. H., Gremse, D. A., Herman, B., ... & Percelay, J. (2016). Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants. Pediatrics, 137(5), e20160590 (May 2016). [PDF] A correction regarding anemia appeared, but, "The corrected algorithm appears in the online version of this article." **Clinical Practice Guideline from American Academy of Pediatrics.
Chow, Jessica ,MD; Bin, Steven, MD. PEM Pearls: Brief Resolved Unexplained Events (BRUE). ALIEM; Academic Life in Emergency Medicine. February 1st, 2017.**Nice precis of definitions, inclusions and exclusions, and approach.
Mills, William A., MD; Levine, Amy, MD. Which Is BRUE. Emergency Physicians Monthly. July 8, 2016. **Summary of management.
Esch, Mackenzie, MD; Levine, Amy, MD. When Techie Baby Monitors Cry Wolf. Emergency Physicians Monthly. October 12, 2017. **Of interest re consumer monitors for apnea.
Tieder, JS, MD. Brief Resolved Unexplained Events (BRUE) Criteria for Infants. MDCalc.com. No Date, but ©2005-2018. **Diagrammatic calculator for Is/Is Not determination of BRUE by the Lead Author of the AAP Guideline.
Carolan, Patrick L., MD. Brief Resolved Unexplained Events (Apparent Life-Threatening Events). emedicine.medscape.com. Updated: Dec 12, 2017. **Additional background data and suggested management and evaluations.
Fox, Sean, MD. BRUE. pedemmorsels.com. Published September 2,2016. Updated July 23, 2017. **Advice from a PEM specialist.
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