Nassr Nama, Kara Picco, Polina Kyrychenko, Jeffrey N Bone, Julie Quet, Jessica L Foulds, Josée Anne Gagnon, Chris Novak, Brigitte Parisien, Matthew Donlan, Ran D Goldman, Anupam Sehgal, Ronik Kanani, Joanna Holland, Sanjay Mahant, Eric Coon, Joel S Tieder, Peter J Gill
{"title":"一项加拿大多中心队列研究：医院间对婴儿短暂解决的不明原因事件（BRUE）处理的差异","authors":"Nassr Nama, Kara Picco, Polina Kyrychenko, Jeffrey N Bone, Julie Quet, Jessica L Foulds, Josée Anne Gagnon, Chris Novak, Brigitte Parisien, Matthew Donlan, Ran D Goldman, Anupam Sehgal, Ronik Kanani, Joanna Holland, Sanjay Mahant, Eric Coon, Joel S Tieder, Peter J Gill","doi":"10.1002/jhm.70094","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Guidelines on Brief Resolved Unexplained Event (BRUE) only provide recommendations for infants categorized at lower risk. However, most infants fall into the higher-risk category, leaving management decisions to individual clinicians and contributing to variation in care.</p><p><strong>Objectives: </strong>Describe interhospital variation in BRUE management and determine whether higher resource utilization improves detection of serious underlying diagnoses.</p><p><strong>Methods: </strong>This multicenter observational cohort (2017-2021) included infants (< 12 months) with BRUE at eight Canadian hospitals. We recorded admission, and use of electrocardiograms (ECG), electroencephalograms (EEG), antibiotic and anti-reflux medications, and subspecialty consultations. Multivariable median regression evaluated the association between tests/interventions and length of stay (LOS), and logistic regression assessed whether site-level resource use correlated with serious underlying diagnoses detection.</p><p><strong>Results: </strong>Of 758 infants (92% higher-risk), we noted variation in admission rates (32%-76%, p < .001), ICU admissions (0%-20%, p < .001), median LOS (0.8-2.0 days, p < .001), ECG (24%-78%, p < .001), EEG (8%-29%, p = .001), and anti-reflux medication (0%-21%, p < .001). Five percent had a serious underlying diagnosis, with no significant site differences (0%-8%, p = .49). Median regression showed EEG (19.9 h, 95% CI: 6.8-33.0, p = .03), empiric antibiotics (15.8 h, 95% CI: 4.7-26.9, p = .03), and subspecialty consultation (17.0 h, 95% CI: 10.8-23.2, p < .001) were associated with longer LOS. Higher resource use did not increase detection of serious underlying diagnoses.</p><p><strong>Conclusions: </strong>Substantial variation exists in BRUE management, associated with prolonged LOS. Higher admission and testing were not associated with increased detection of serious underlying diagnoses. These findings highlight the need for standardized care approaches.</p>","PeriodicalId":94084,"journal":{"name":"Journal of hospital medicine","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Interhospital variation in the management of Brief Resolved Unexplained Events (BRUE) in infants: A Canadian multicenter cohort study.\",\"authors\":\"Nassr Nama, Kara Picco, Polina Kyrychenko, Jeffrey N Bone, Julie Quet, Jessica L Foulds, Josée Anne Gagnon, Chris Novak, Brigitte Parisien, Matthew Donlan, Ran D Goldman, Anupam Sehgal, Ronik Kanani, Joanna Holland, Sanjay Mahant, Eric Coon, Joel S Tieder, Peter J Gill\",\"doi\":\"10.1002/jhm.70094\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Guidelines on Brief Resolved Unexplained Event (BRUE) only provide recommendations for infants categorized at lower risk. However, most infants fall into the higher-risk category, leaving management decisions to individual clinicians and contributing to variation in care.</p><p><strong>Objectives: </strong>Describe interhospital variation in BRUE management and determine whether higher resource utilization improves detection of serious underlying diagnoses.</p><p><strong>Methods: </strong>This multicenter observational cohort (2017-2021) included infants (< 12 months) with BRUE at eight Canadian hospitals. We recorded admission, and use of electrocardiograms (ECG), electroencephalograms (EEG), antibiotic and anti-reflux medications, and subspecialty consultations. Multivariable median regression evaluated the association between tests/interventions and length of stay (LOS), and logistic regression assessed whether site-level resource use correlated with serious underlying diagnoses detection.</p><p><strong>Results: </strong>Of 758 infants (92% higher-risk), we noted variation in admission rates (32%-76%, p < .001), ICU admissions (0%-20%, p < .001), median LOS (0.8-2.0 days, p < .001), ECG (24%-78%, p < .001), EEG (8%-29%, p = .001), and anti-reflux medication (0%-21%, p < .001). Five percent had a serious underlying diagnosis, with no significant site differences (0%-8%, p = .49). Median regression showed EEG (19.9 h, 95% CI: 6.8-33.0, p = .03), empiric antibiotics (15.8 h, 95% CI: 4.7-26.9, p = .03), and subspecialty consultation (17.0 h, 95% CI: 10.8-23.2, p < .001) were associated with longer LOS. Higher resource use did not increase detection of serious underlying diagnoses.</p><p><strong>Conclusions: </strong>Substantial variation exists in BRUE management, associated with prolonged LOS. Higher admission and testing were not associated with increased detection of serious underlying diagnoses. These findings highlight the need for standardized care approaches.</p>\",\"PeriodicalId\":94084,\"journal\":{\"name\":\"Journal of hospital medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-06-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of hospital medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1002/jhm.70094\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of hospital medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/jhm.70094","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Interhospital variation in the management of Brief Resolved Unexplained Events (BRUE) in infants: A Canadian multicenter cohort study.
Background: Guidelines on Brief Resolved Unexplained Event (BRUE) only provide recommendations for infants categorized at lower risk. However, most infants fall into the higher-risk category, leaving management decisions to individual clinicians and contributing to variation in care.
Objectives: Describe interhospital variation in BRUE management and determine whether higher resource utilization improves detection of serious underlying diagnoses.
Methods: This multicenter observational cohort (2017-2021) included infants (< 12 months) with BRUE at eight Canadian hospitals. We recorded admission, and use of electrocardiograms (ECG), electroencephalograms (EEG), antibiotic and anti-reflux medications, and subspecialty consultations. Multivariable median regression evaluated the association between tests/interventions and length of stay (LOS), and logistic regression assessed whether site-level resource use correlated with serious underlying diagnoses detection.
Results: Of 758 infants (92% higher-risk), we noted variation in admission rates (32%-76%, p < .001), ICU admissions (0%-20%, p < .001), median LOS (0.8-2.0 days, p < .001), ECG (24%-78%, p < .001), EEG (8%-29%, p = .001), and anti-reflux medication (0%-21%, p < .001). Five percent had a serious underlying diagnosis, with no significant site differences (0%-8%, p = .49). Median regression showed EEG (19.9 h, 95% CI: 6.8-33.0, p = .03), empiric antibiotics (15.8 h, 95% CI: 4.7-26.9, p = .03), and subspecialty consultation (17.0 h, 95% CI: 10.8-23.2, p < .001) were associated with longer LOS. Higher resource use did not increase detection of serious underlying diagnoses.
Conclusions: Substantial variation exists in BRUE management, associated with prolonged LOS. Higher admission and testing were not associated with increased detection of serious underlying diagnoses. These findings highlight the need for standardized care approaches.
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