Purpose: In 2016, the Subcommittee on Apparent Life-Threatening Events (ALTE) of the American Academy of Pediatrics (AAP) published a clinical practice guideline renaming ALTE as Brief Resolved Unexplained Events (BRUE). The purpose of this study is to identify the proportion of patients previously diagnosed with apparent life-threatening events (ALTE) who would meet criteria for brief resolved unexplained events (BRUE) and to identify rates of significant outcomes in the following subgroups: ALTE not meeting criteria for BRUE, low-risk BRUE, and non-low-risk BRUE. Methods: We performed a secondary analysis of a single-center prospective registry of patients diagnosed with ALTE at a tertiary care emergency department from March 1, 1997 to October 31, 2007. Hospital encounters were followed longitudinally to identify significant outcomes. We identified the proportion of patients meeting criteria for BRUE and the proportion of patients with BRUE meeting low-risk criteria. We assessed outcomes of patients in all subgroups and calculated the relative risk of significant outcomes in patients with low-risk BRUE to non-low-risk BRUE. Results: 762 patients were included, (393 [51.6%] female; median age 1.5 (IQR 0.8-3.0) months (Table). Significant outcomes included recurrent ALTE (n=49), aspiration (n=9), trauma (n=9), and death (n=4). 326/726 (42.8%) met criteria for BRUE, with reasons for exclusion being: age >12 months of age (n=28), not having at least one defining characteristic of BRUE (n=21) or the presence of an alternative explanation of the event on history of physical examination (n=387). Of those patients defined as BRUE, 71/326 (21.8%) met criteria for low-risk BRUE (Figure). Significant outcomes occurred in 40/436 (9.2%) with ALTE not meeting criteria for BRUE, 2/71 (2.8%) with low-risk BRUE, and 23/255 (9.0%) with non-low-risk BRUE. The relative risk between significant outcomes in patients with low-risk BRUE to patients with non-low-risk BRUE did not reach statistical significance (0.31, 95% confidence interval, 0.08-1.29). Of the four patients who died, one had an ALTE not meeting criteria for BRUE and three had non low-risk BRUE. Conclusion: Less than half of patients with ALTE met criteria for BRUE. Of those who did, one-fifth were low-risk. Rates of significant outcomes were lower in patients who would have been diagnosed with a low-risk BRUE, but this did not reach statistical significance. As only a minority of patients with ALTE have BRUE, the ability to translate previous research on ALTE to current day practice is limited. Further research is required to better risk-stratify patients with BRUE.

Table.

Demographics of population overall and in subgroups

ALTE, apparent life-threatening event; BRUE, brief resolved unexplained event; CPR, cardiopulmonary resuscitation. *Color change for ALTE defined as any color changed reported by parent, whereas color change for BRUE is defined as cyanosis or pallor only.

Table.

Demographics of population overall and in subgroups

ALTE, apparent life-threatening event; BRUE, brief resolved unexplained event; CPR, cardiopulmonary resuscitation. *Color change for ALTE defined as any color changed reported by parent, whereas color change for BRUE is defined as cyanosis or pallor only.

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Figure.

Identification of patients with BRUE among patients with ALTEs.

*As patients had more than one characteristic meeting criteria, numbers do not sum to 100%.

Figure.

Identification of patients with BRUE among patients with ALTEs.

*As patients had more than one characteristic meeting criteria, numbers do not sum to 100%.

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