BRUE (Pediatrics)

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)