(347) The Impact of AAP Guidelines on Brief Resolved Unexplained Events: A National Database Study

Introduction: The American Academy of Pediatrics released updated clinical practice guidelines in May of 2016 for brief resolved unexplained events (BRUEs), formerly apparent life-threatening events (ALTEs). These guidelines provide a more precise definition, emphasizing that BRUE is a diagnosis of exclusion not explained by another medical condition and that patients in the low-risk category may not require further workup. We utilized a national-level inpatient database to evaluate changes in admission rates and management of BRUE following the release of the AAP guidelines.

Methods: We analyzed the Kids’ Inpatient Database (KID) for prevalence of BRUE-related hospitalizations across 4,000 community hospitals in 2016 and 2019. We compared demographics, associated diagnoses, testing and procedures performed, length of stay, and hospital charges using chi-squared and Mann-Whitney-U tests.

Results: A total of 19,332 BRUE-related admissions were identified (11,652 in 2016; 7,680 in 2019). Prevalence of BRUE admissions decreased from 0.27% in 2016 to 0.19% in 2019 (p < 0.001). When analyzed month by month, BRUE admission rates begin decreasing from April to May of 2016, and continue to decrease through the remainder of 2016, ultimately matching BRUE admission rates in 2019. Linear-by-linear association analysis showed a significant association between AAP guideline publication and BRUE admissions (p < 0.001). The proportion of cases with a second diagnosis decreased from 60.1% in 2016 to 52.4% in 2019 (p < 0.001). These decreases were seen among some of the most common BRUE mimics, including GERD and bronchiolitis. Patients in 2019 had lower rates of bronchoscopy and abdominal ultrasound but higher rates of EEG. No differences were seen in the use of neuroimaging, echocardiography, or endotracheal intubation. Lengths of stay were similar between 2016 and 2019. With adjustment for inflation, hospital charges increased from 2016 (mean $33,142, SD 99,154) to 2019 (mean $39,140, SD 109,040, p< 0.001).

Conclusions: Lower admission rates for BRUE were seen in 2019 compared to 2016. Patients admitted for BRUE in 2019 were less likely to have additional diagnoses. These findings may represent the impact of the AAP guidelines on clinical practice.