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1.
Acad Emerg Med ; 31(7): 667-674, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38426635

RESUMEN

OBJECTIVES: The aim of this study was to describe the incidence of brief resolved unexplained events (BRUEs) and compare the impact of a national clinical practice guideline (CPG) on admission and diagnostic testing practices between general and pediatric emergency departments (EDs). METHODS: Using the Nationwide Emergency Department Sample for 2012-2019, we conducted a cross-sectional study of children <1 year of age with an International Classification of Diseases diagnostic code for BRUE. Population incidence rate was estimated using Centers for Disease Control and Prevention birth data. ED incidence rate was estimated for all ED encounters. We used interrupted time series to evaluate the associated impact of the CPG publication on the outcomes of ED disposition (discharge, admission, and transfer) and electrocardiogram (ECG) use. RESULTS: Of 133,972 encounters for BRUE, 80.0% occurred in general EDs. BRUE population incidence was 4.28 per 1000 live births and the annual incidence remained stable (p = 0.19). BRUE ED incidence was 5.06 per 1000 infant ED encounters (p = 0.14). The impact of the BRUE CPG on admission rates was limited to pediatric EDs (level shift -23.3%, p = 0.002). Transfers from general EDs did not change with the CPG (level shift 2.2%, p = 0.17). After the CPG was published, ECGs increased by 13.7% in pediatric EDs (p = 0.005) but did not change in general EDs (level shift -0.2%, p = 0.82). CONCLUSIONS: BRUEs remain a common pediatric problem at a population level and in EDs. Although a disproportionate number of infants present to general EDs, there is differential uptake of the CPG recommendations between pediatric and general EDs. These findings may support quality improvement opportunities aimed at improving care for these infants and decreasing unnecessary hospital admissions or transfers.


Asunto(s)
Servicio de Urgencia en Hospital , Guías de Práctica Clínica como Asunto , Humanos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicio de Urgencia en Hospital/normas , Estudios Transversales , Femenino , Masculino , Lactante , Incidencia , Recién Nacido , Evento Inexplicable, Breve y Resuelto/diagnóstico , Evento Inexplicable, Breve y Resuelto/terapia , Evento Inexplicable, Breve y Resuelto/epidemiología , Estados Unidos/epidemiología , Electrocardiografía
2.
Pediatrics ; 148(5)2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34607936

RESUMEN

BACKGROUND AND OBJECTIVES: Most young infants presenting to the emergency department (ED) with a brief resolved unexplained event (BRUE) are hospitalized. We sought to determine the rate of explanatory diagnosis after hospitalization for a BRUE. METHODS: This was a multicenter retrospective cohort study of infants hospitalized with a BRUE after an ED visit between October 1, 2015, and September 30, 2018. We included infants without an explanatory diagnosis at admission. We determined the proportion of patients with an explanatory diagnosis at the time of hospital discharge and whether diagnostic testing, consultation, or observed events occurring during hospitalization were associated with identification of an explanatory diagnosis. RESULTS: Among 980 infants hospitalized after an ED visit for a BRUE without an explanatory diagnosis at admission, 363 (37.0%) had an explanatory diagnosis identified during hospitalization. In 805 (82.1%) infants, diagnostic testing, specialty consultations, and observed events did not contribute to an explanatory diagnosis, and, in 175 (17.9%) infants, they contributed to the explanatory diagnosis (7.0%, 10.0%, and 7.0%, respectively). A total of 15 infants had a serious diagnosis (4.1% of explanatory diagnoses; 1.5% of all infants hospitalized with a BRUE), the most common being seizure and infantile spasms, occurring in 4 patients. CONCLUSIONS: Most infants hospitalized with a BRUE did not receive an explanation during the hospitalization, and a majority of diagnoses were benign or self-limited conditions. More research is needed to identify which infants with a BRUE are most likely to benefit from hospitalization for determining the etiology of the event.


Asunto(s)
Evento Inexplicable, Breve y Resuelto/diagnóstico , Hospitalización , Evento Inexplicable, Breve y Resuelto/epidemiología , Servicio de Urgencia en Hospital , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos
3.
Acad Pediatr ; 19(8): 963-968, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31401230

RESUMEN

OBJECTIVE: To identify the proportion of patients previously diagnosed with apparent life-threatening events (ALTE) who would meet criteria for brief resolved unexplained events (BRUE) and to identify rates of adverse outcomes in subgroups: ALTE not meeting criteria for BRUE, lower-risk BRUE, and higher-risk ALTE. METHODS: We performed a secondary analysis of a single-center prospective registry of patients diagnosed with ALTE in a tertiary care emergency department from March 1, 1997 to October 31, 2007. We identified the proportion of patients meeting criteria for BRUE, and the proportion of patients with BRUE meeting lower-risk criteria. We assessed outcomes of patients in subgroups. RESULTS: Seven hundred and sixty-two patients were included. Adverse outcomes included recurrent ALTE (n = 49), aspiration (n = 9), trauma (n = 8), and death (n = 4). Three hundred and twenty-six of 762 (42.8%) met criteria for BRUE. Seventy of 326 (21.5%) met criteria for lower-risk BRUE. Adverse outcomes occurred in 40 of 436 (9.2%) with ALTE not meeting criteria for BRUE, 2 of 70 (2.9%) with lower-risk BRUE, and 23 of 256 (9.0%) with higher-risk BRUE. Of 4 patients who died, 1 had an ALTE not meeting criteria for BRUE and 3 had non-lower-risk BRUE. The BRUE risk criteria identified all BRUE patients that died or had substantial morbidity as higher-risk. CONCLUSIONS: Less than half of patients with ALTE meet criteria for BRUE. Of those who do, one-fifth is lower-risk. In this series, the risk-stratification in the BRUE criteria identified those patients at highest risk of adverse outcomes. Further research is required to risk-stratify patients with BRUE.


Asunto(s)
Apnea/diagnóstico , Evento Inexplicable, Breve y Resuelto/diagnóstico , Cianosis/diagnóstico , Hipotonía Muscular/diagnóstico , Palidez/diagnóstico , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/epidemiología , Obstrucción de las Vías Aéreas/terapia , Apnea/epidemiología , Apnea/terapia , Evento Inexplicable, Breve y Resuelto/epidemiología , Evento Inexplicable, Breve y Resuelto/terapia , Reanimación Cardiopulmonar , Cianosis/epidemiología , Cianosis/terapia , Bases de Datos Factuales , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Masculino , Mortalidad , Hipotonía Muscular/epidemiología , Hipotonía Muscular/terapia , Palidez/epidemiología , Palidez/terapia , Recurrencia , Sistema de Registros , Trastornos Respiratorios/diagnóstico , Trastornos Respiratorios/epidemiología , Trastornos Respiratorios/terapia , Aspiración Respiratoria/epidemiología , Medición de Riesgo , Factores de Riesgo , Muerte Súbita del Lactante/epidemiología , Heridas y Lesiones/epidemiología
4.
Rev Esp Enferm Dig ; 106(3): 159-64, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25007014

RESUMEN

INTRODUCTION: The conventional 24-hour pH monitoring is the gold standard for the diagnosis of gastro-esophageal reflux (GER), a possible cause of Apparent Life Threatening Episodes (ALTE). However, multichannel intraluminal impedance (MII) may provide advantages. OBJECTIVES: Comparison of the results of MII and pH monitoring in patients undergoing MII-pH monitoring in the 3-year study period because of having suffered from ALTE. MATERIAL AND METHODS: Prospective study of MII-pH monitoring performed in our unit to infants < 12 months of ageadmitted for ALTE for a 3-year period. RESULTS: Thirty nine patients studied. 2,692 pH monitoring episodes, with median of 24 (IQ: 15-44) episodes/patient, 1.30 (IQ: 0.80-2.60) reflux/hour, 1 (IQ: 0-4) reflux episode > 5 min per patient and clearance of 1.20 (IQ: 0.70-2.20) min/reflux. With pH monitoring analysis, 14 children (35.9 %) could have been diagnosed as GER (8 mild, 4 moderate and 2 severe) based on the classical criteria. MII identified a total of 8,895 events; only 3,219 among them were refluxes, with a median of 75 (IQ: 54-111) per patient, 1.30 (IQ: 1.3-2.6) episodes/hour). With MII-pH monitoring combination there were 21.60 (SD 15.21) acid reflux episodes, 67.33 weekly acid (SD 32.09) and 3.34 (SD 7.23) non-acid, being finally diagnosed 33 patients as GER. CONCLUSIONS: The association of pH monitoring and MII provides additional information that improves GER diagnostic performance without posing any additional risk to the infant patient. The non-acid/weekly acid refluxes, not detected by pH monitoring, account for a high percentage of episodes, this may have diagnostic and therapeutic significance, especially in infants. Further studies are needed to assess the normality of MMI in pediatric patients.


Asunto(s)
Evento Inexplicable, Breve y Resuelto/diagnóstico , Impedancia Eléctrica , Monitorización del pH Esofágico , Reflujo Gastroesofágico/diagnóstico , Evento Inexplicable, Breve y Resuelto/epidemiología , Evento Inexplicable, Breve y Resuelto/fisiopatología , Niño , Preescolar , Femenino , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/fisiopatología , Humanos , Lactante , Masculino , Estudios Prospectivos , Estudios Retrospectivos
5.
Rev. cuba. pediatr ; 85(4): 517-522, oct.-dic. 2013.
Artículo en Español | LILACS | ID: lil-697513

RESUMEN

El ALTE no es una enfermedad específica en sí misma, sino una forma de presentación clínica de diversas enfermedades, su incidencia se estima en 6 por 1 000 en aquellos lactantes nacidos a término, y asciende a un 86 por 1 000 en los nacidos pretérmino. Su etiología es multifactorial, el diagnóstico es difícil y precisa de experiencia, y la conducta depende de las causas que lo originen. Esta afección poco reconocida en la práctica médica actual, genera una enorme ansiedad en la familia, y constituye un desafío en cuanto al diagnóstico, manejo y consejos por parte del pediatra


Apparent life-threatening event (ALTE) is not a specific disease, rather a form of clinical presentation of several diseases. Its incidence rate is estimated to be 6 per 1000 in the term infants and 86 per 1000 in preterm infants. The etiology of the event is multifactoral, the diagnosis is difficult and requires experience, and the behavior to be adopted depends on the causes that bring it about. This poorly recognized illness in the present medical practice gives rise to a lot of anxiety for the family and represents a true challenge in terms of diagnosis, management and counseling by the pediatrician


Asunto(s)
Humanos , Recién Nacido , Lactante , Preescolar , Niño , Evento Inexplicable, Breve y Resuelto/diagnóstico , Evento Inexplicable, Breve y Resuelto/epidemiología , Evento Inexplicable, Breve y Resuelto/prevención & control , Diagnóstico Clínico/diagnóstico
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