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3 Categories: High Risk BRUE. Low Risk BRUE. Not a BRUE.

Step 1: Is This a BRUE?

  • Brief
    • <60 seconds
  • Resolved
    • Exam and vitals back to baseline in the ED
  • Unexplained
    • No symptoms other than event itself
  • Event
    • Concerning change in any of the following…
      • Tone
      • Color
      • Breathing
      • Mental status

Step 2: Is This Low Risk BRUE?

  • Five low risk criteria
    • Age >2 months
    • Born at >32 weeks gestational age
    • First and only episode
    • No CPR by medical providers
    • No “Red Flags”

Step 3: Do They Have Red Flags?

  • For abuse
    • History of SIDS/BRUE in sibling
    • Mental illness at home
    • Drug use at home
  • For dysrhythmia
    • Family history of sudden unexplained death
  • For infection
    • Fevers
    • Unimmunized
    • Sick contacts
    • Rash

Step 4: Examine for Non-Accidental Trauma

  • Bulging fontanelle
  • Petechia
  • Torn frenulum
  • Blood

Step 5: Place Patient Into One of Three Categories

  • NOT a BRUE
    • Treat as you normally would
  • HIGH risk BRUE
    • Admit
  • LOW risk BRUE
    • Discharge without testing
    • May consider EKG and pertussis

Additional Reading

  • Brief Resolved Unexplained Events (AAP)