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    Patent Pending

    Brief Resolved Unexplained Events (BRUE) Criteria for Infants

    Classifies unexplained events and replaces the Apparent Life Threatening Events (ALTE) classification.


    BRUE has been updated. BRUE 2.0 has been recommended as a replacement for the older tool. Click here to view.


    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.

    When to Use
    Why Use

    Infants <1 year old presenting for evaluation after a brief, unexplained, and now resolved event consisting of ≥1 of the following:

    • Cyanosis or pallor.
    • Absent, decreased, or irregular breathing.
    • Marked change in tone.
    • Altered level of responsiveness.
    • Developed via expert consensus by the American Academy of Pediatrics (AAP).
    • The criteria require that an extensive history and physical examination have failed to reveal a cause of the episode.
    • Can be used in inpatient, outpatient, and emergency department settings.
    • Note that choking, gagging, and red color change, which were part of the ALTE definition, are not part of the BRUE Criteria.
    • Risk is defined by the likelihood of adverse recurrent events or eventual diagnosis of a serious underlying disorder.
    • BRUEs represent a separate entity from sudden infant death syndrome (SIDS).
    • Replaces the term ALTE, which is broader and does not identify patients who are lower risk.
    • May give providers comfort in discharging lower risk BRUE patients home.
    • May reduce the need for unnecessary diagnostic testing which may be invasive and expensive.
    Entry criteria

    Must fulfill all 4 to evaluate for BRUE

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Creator Insights
    Dr. Joel S. Tieder

    About the Creator

    Joel S. Tieder, MD, MPH is a Professor of Pediatrics in the Division of Hospital Medicine at Seattle Children’s Hospital and the University Of Washington School Of Medicine. He is a pediatric hospitalist with scholarly focus on improving the delivery of quality care for hospitalized children, particularly through overcoming healthcare disparities and the use of evidence-based and family-centered care. Nationally, he is the Chair for the American Academy of Pediatrics’ Council for Quality Improvement and Patient Safety.

    To view Dr. Joel S. Tieder's publications, visit PubMed

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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Eric Zwemer, MD
    About the Creator
    Dr. Joel S. Tieder
    Are you Dr. Joel S. Tieder?
    Content Contributors
    • Eric Zwemer, MD