Brief Resolved Unexplained Event (BRUE)

Brief Resolved Unexplained Event (BRUE) is now the recommended term for ALTE (Apparent Life Threatening Event).

Definition:

BRUE is defined as an episode in an infant less than 12 months old characterized by:

< 1 minute duration (typically 20-30s)
Followed by return to baseline state
Not explained by identifiable medical conditions

Includes one or more of the following:

Central cyanosis/pallor
Absent, decreased or irregular breathing
Marked change in tone (hyper or hypotonia)
Altered level of consciousness

Algorithm:

* Always consider CHILD-PROTECTION concerns! *

Investigations:

Lower risk: no investigations required, however capillary blood glucose and urinalysis may be performed if clinical concern.
Higher risk: discuss with senior doctor (ED Consultant/Senior/Paediatric Senior)
Consider: FBC, U&C, CRP, glucose, naso-pharyngeal aspirate, blood gas, ECG plus any further investigations felt appropriate based on clinical presentation; and referral to relevant guidelines.

Management:

By definition if patient requiring ongoing treatment, episode is NOT a BRUE. Lower risk patients do not routinely need admitted for cardio-respiratory monitoring.

Lower risk: Discharge home only if:

Low clinical suspicion of serious underlying disorder.
Parents reassured and happy to care for child at home. If not for discussion with paediatric team for period of inpatient observation. (Provide parents carers with education / advice on BRUE, including worsening clinical picture for representation.)

Lower risk does not mean NO risk: Considered for a period of observation if required.

Higher risk: Following discussion with ED Senior/Paediatric Senior, consider admission for observation, cardio-respiratory monitoring and further investigations as guided by presentation.