MDCalc

Brief Resolved Unexplained Events 2.0 (BRUE 2.0) Criteria for Infants

Classifies unexplained events, improves on the BRUE Criteria.

Use in infants <1 year old who are asymptomatic and in their normal state of health at the time of evaluation. Do not use in symptomatic patients (e.g. fever, respiratory distress) or those with obvious cause for prior symptoms.

Entry criteria

Must fulfill all 4 to evaluate for BRUE 2.0

E.g. no URI symptoms, no fever
E.g. GER, feeding difficulties

History of sudden, brief, and now resolved episode consisting of ≥1 of the following:

Diagnostic Result

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Advice

  • Provide education around BRUE and reassurance (see here).

  • Engage in shared decision-making with the families if testing and hospital admission is a consideration using the above calculated risks. This decision needs to be guided by the family’s values, the patient’s risk, worrisome features on history or exam, and access to close follow-up.

  • Provider caregivers with resources on CPR training.

  • Consider a brief period of monitoring for 1-4 hours to obtain serial evaluations of the infant, as well as monitor for event recurrence.

  • Involve a social worker (or a trained provider) to perform a psychosocial assessment, screen for child abuse and provide caregiver support.

  • Feeding evaluation by a trained provider.

  • Consider the need for diagnostic testing (rapid viral panel, and pertussis in high-risk groups).

  • Further consultations and diagnostic testing should be tailored to findings on history and physical examination.

  • Ensure adequate follow-up to evaluate and manage any persistent symptoms.

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