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Risk Prediction After a Brief Resolved Unexplained Event.
Nama, Nassr; Hall, Matt; Neuman, Mark; Sullivan, Erin; Bochner, Risa; De Laroche, Amy; Hadvani, Teena; Jain, Shobhit; Katsogridakis, Yiannis; Kim, Edward; Mittal, Manoj; Payson, Alison; Prusakowski, Melanie; Shastri, Nirav; Stephans, Allayne; Westphal, Kathryn; Wilkins, Victoria; Tieder, Joel.
Afiliación
  • Nama N; Division of General Pediatrics, Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada.
  • Hall M; Children's Hospital Association, Lenexa, Kansas.
  • Neuman M; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
  • Sullivan E; Department of Pediatrics, University of Washington, Seattle Children's Core for Biomedical Statistics, Seattle, Washington.
  • Bochner R; SUNY Downstate Health Sciences University/New York City Health and Hospitals/Kings County Hospital, New York City, New York.
  • De Laroche A; Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan.
  • Hadvani T; Division of Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas.
  • Jain S; Division of Emergency Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Kansas.
  • Katsogridakis Y; Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
  • Kim E; Division of Pediatric Hospital Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
  • Mittal M; Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Payson A; Nicklaus Children's Hospital, Miami, Florida.
  • Prusakowski M; Department of Emergency Medicine, Carilion Clinic, Roanoke, Virginia.
  • Shastri N; Division of Emergency Medicine, Department of Pediatrics, Children's Mercy Hospital, Kansas City, Kansas.
  • Stephans A; Rainbow Babies and Children's Hospital, Cleveland, Ohio.
  • Westphal K; Division of Hospital Medicine, Nationwide Children's Hospital, Columbus, Ohio.
  • Wilkins V; Division of Pediatric Hospital Medicine, University of Utah, Primary Children's Hospital, Salt Lake City, Utah.
  • Tieder J; Division of Pediatric Hospital Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington.
Hosp Pediatr ; 12(9): 772-785, 2022 09 01.
Article en En | MEDLINE | ID: mdl-35965279
OBJECTIVES: Only 4% of brief resolved unexplained events (BRUE) are caused by a serious underlying illness. The American Academy of Pediatrics (AAP) guidelines do not distinguish patients who would benefit from further investigation and hospitalization. We aimed to derive and validate a clinical decision rule for predicting the risk of a serious underlying diagnosis or event recurrence. METHODS: We retrospectively identified infants presenting with a BRUE to 15 children's hospitals (2015-2020). We used logistic regression in a split-sample to derive and validate a risk prediction model. RESULTS: Of 3283 eligible patients, 565 (17.2%) had a serious underlying diagnosis (n = 150) or a recurrent event (n = 469). The AAP's higher-risk criteria were met in 91.5% (n = 3005) and predicted a serious diagnosis with 95.3% sensitivity, 8.6% specificity, and an area under the curve of 0.52 (95% confidence interval [CI]: 0.47-0.57). A derived model based on age, previous events, and abnormal medical history demonstrated an area under the curve of 0.64 (95%CI: 0.59-0.70). In contrast to the AAP criteria, patients >60 days were more likely to have a serious underlying diagnosis (odds ratio:1.43, 95%CI: 1.03-1.98, P = .03). CONCLUSIONS: Most infants presenting with a BRUE do not have a serious underlying pathology requiring prompt diagnosis. We derived 2 models to predict the risk of a serious diagnosis and event recurrence. A decision support tool based on this model may aid clinicians and caregivers in the discussion on the benefit of diagnostic testing and hospitalization (https://www.mdcalc.com/calc/10400/brief-resolved-unexplained-events-2.0-brue-2.0-criteria-infants).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Evento Inexplicable, Breve y Resuelto Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Child / Humans / Infant Idioma: En Revista: Hosp Pediatr Año: 2022 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Evento Inexplicable, Breve y Resuelto Tipo de estudio: Etiology_studies / Guideline / Observational_studies / Prognostic_studies / Qualitative_research / Risk_factors_studies Límite: Child / Humans / Infant Idioma: En Revista: Hosp Pediatr Año: 2022 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Estados Unidos