As this week I had to complete the new course coordinator orientation in preparation for teaching the 4th edition of Pediatric Education for Pre-hospital Professionals (PEPP) programme, an excellent CPD course which Susie and I have taught since the 1st edition of the programme nearly 18 years ago, it seems appropriate that this week’s Ramblings from Red Shift should look at paediatrics.
Recently I attended a two month old child who had a short episode of altered level of consciousness, dyspnoea and cyanosis, at the time of assessment though, the child was alert, smiling and without any adverse symptoms. The child was conveyed to hospital where they were kept overnight, influenced by a family history of a paediatric sudden death several years earlier.
Brief Resolved Unexplained Event (BRUE) replaced the previous terminology of an Acute Life-Threatening Event (ALTE) following the American Academy of Pediatrics (AAP) revision of the guideline in 2016 – it was thought that ALTEs by definition were subjective and made determining diagnosis, treatment or prognosis difficult. BRUE is described as an event observed in an infant (<1 year) which is sudden, brief (<1 minute), now resolved and unexplained involving at least one of:
- Colour change – central cyanosis or pallor only;
- Breathing change – absent, decreased or irregular;
- Marked change in tone – hypertonia or hypotonia; and
- Altered level of responsiveness.
There are many medical causes of BRUE-like events. The term BRUE is applied only when a medical cause of the event is not established. It should also be noted that recurrences generally occur within the first 24 hours of the first episode.
Perth Children’s Hospital Clinical Practice Guideline for BRUE can be read here:
Further reading can be found here:
The original ACP guidelines can be read here:
https://pediatrics.aappublications.org/content/pediatrics/early/2016/04/21/peds.2016-0590.full.pdf
For those podcast listeners, we have found a couple on BRUE:
https://www.pedscases.com/brief-resolved-unexplained-events-part-1
