Brief Resolved Unexplained Event: Evidence-Based and Family-Centered Management.

IF 1.2 Q3 PEDIATRICS
Nassr Nama, Amy DeLaroche, Joshua L Bonkowsky, David Gremse, Joel S Tieder
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引用次数: 0

Abstract

Brief resolved unexplained events (BRUEs) are frequently encountered in infants younger than 1 year. By definition, these events require the infant to be asymptomatic and at baseline at the time of presentation, with no significant abnormalities on examination and no discernible explanatory diagnosis. Research has shown that less than 5% of BRUE cases are attributable to serious underlying conditions, with no increased mortality risk and no increased risk of sudden infant death syndrome. Despite these findings, approximately 63% of patients with BRUEs are hospitalized and up to 82% undergo diagnostic tests, which predominantly result in false-positive findings. Such results may lead to unnecessarily prolonged hospital stays, additional tests or consultations, and increased parental anxiety. The management of a patient who has experienced a BRUE can be challenging for providers and parents alike. Although risk is known to be low in these infants, providers may be compelled to explain the event and provide reassurance. Caregivers oftentimes are concerned that the events may reoccur and be a harbinger of a missed diagnosis. Shared decision-making can be used to explain risk and the benefit of additional testing and hospitalization. This family-centered strategy can align care with the family's values, provide reassurance, and decrease decisional conflict.

短暂的无法解释事件:以证据为基础、以家庭为中心的管理。
1 岁以下的婴儿经常会出现短暂缓解的不明原因事件(BRUEs)。根据定义,这些事件要求婴儿在发病时无症状且处于基线状态,检查无明显异常,也没有可解释的诊断。研究表明,只有不到 5%的 BRUE 病例可归因于严重的潜在疾病,不会增加死亡率和婴儿猝死综合症的风险。尽管有这些研究结果,但仍有约 63% 的 BRUE 患者住院治疗,多达 82% 的患者接受了诊断性检查,而这些检查的主要结果是假阳性。这些结果可能会导致不必要的住院时间延长、额外的检查或会诊,并增加父母的焦虑。对于医护人员和家长来说,如何处理发生 BRUE 的患者都是一项挑战。虽然已知这些婴儿的风险很低,但医疗服务提供者可能不得不解释这一事件并提供安慰。护理人员通常担心这些事件可能会再次发生,并成为漏诊的先兆。共同决策可用于解释风险以及额外检查和住院治疗的益处。这种以家庭为中心的策略可以使护理符合家庭的价值观、提供保证并减少决策冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pediatrics in review
Pediatrics in review 医学-小儿科
CiteScore
1.30
自引率
0.00%
发文量
109
期刊介绍: Pediatrics in Review (PIR) is the American Academy of Pediatrics’ monthly peer-reviewed continuing medical education journal, designed to keep the general pediatric clinician current in all areas of pediatric medicine and to assist those participating in the Maintenance of Certification program of the American Board of Pediatrics (ABP). The journal is one of the key components of the Academy’s continuing medical education program: PREP® (the Pediatrics Review and Education Program). Together, PIR and the PREP Self-Assessment comprise PREP The Curriculum®. Each PIR review article includes quiz questions formulated by topic experts.
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