{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T05:50:44Z","timestamp":1791611444019,"version":"4.3.4"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Pediatr"],"published-print":{"date-parts":[[2025,2,1]]},"abstract":"<jats:sec id=\"ab-poi240078-4\"><jats:title>Importance<\/jats:title><jats:p>The American Academy of Pediatrics (AAP) higher-risk criteria for brief resolved unexplained events (BRUE) have a low positive predictive value (4.8%) and misclassify most infants as higher risk (&amp;amp;gt;90%). New BRUE prediction rules from a US cohort of 3283 infants showed improved discrimination; however, these rules have not been validated in an external cohort.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240078-5\"><jats:title>Objective<\/jats:title><jats:p>To externally validate new BRUE prediction rules and compare them with the AAP higher-risk criteria.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240078-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was a retrospective multicenter cohort study conducted from 2017 to 2021 and monitored for 90 days after index presentation. The setting included infants younger than 1 year with a BRUE identified through retrospective chart review from 11 Canadian hospitals. Study data were analyzed from March 2022 to March 2024.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240078-7\"><jats:title>Exposures<\/jats:title><jats:p>The BRUE prediction rules.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240078-8\"><jats:title>Main Outcome and Measure<\/jats:title><jats:p>The primary outcome was a serious underlying diagnosis, defined as conditions where a delay in diagnosis could lead to increased morbidity or mortality.<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240078-9\"><jats:title>Results<\/jats:title><jats:p>Of 1042 patients (median [IQR] age, 41 [13-84] days; 529 female [50.8%]), 977 (93.8%) were classified as higher risk by the AAP criteria. A total of 79 patients (7.6%) had a serious underlying diagnosis. For this outcome, the AAP criteria demonstrated a sensitivity of 100.0% (95% CI, 95.4%-100.0%), a specificity of 6.7% (95% CI, 5.2%-8.5%), a positive likelihood ratio (LR+) of 1.07 (95% CI, 1.05-1.09), and an AUC of 0.53 (95% CI, 0.53-0.54). The BRUE prediction rule for discerning serious diagnoses displayed an AUC of 0.60 (95% CI, 0.54-0.67; calibration intercept: 0.60), which improved to an AUC of 0.71 (95% CI, 0.65-0.76; <jats:italic>P<\/jats:italic>\u2009&amp;amp;lt;\u2009.001; calibration intercept: 0.00) after model revision. Event recurrence was noted in 163 patients (15.6%). For this outcome, the AAP criteria yielded a sensitivity of 99.4% (95% CI, 96.6%-100.0%), a specificity of 7.3% (95% CI, 5.7%-9.2%), an LR+ of 1.07 (95% CI, 1.05-1.10), and an AUC of 0.58 (95% CI, 0.56-0.58). The AUC of the prediction rule stood at 0.67 (95% CI, 0.62-0.72; calibration intercept: 0.15).<\/jats:p><\/jats:sec><jats:sec id=\"ab-poi240078-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Results of this multicenter cohort study show that the BRUE prediction rules outperformed the AAP higher-risk criteria on external geographical validation, and performance improved after recalibration. These rules provide clinicians and families with a more precise tool to support decision-making, grounded in individual risk tolerance.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamapediatrics.2024.4399","type":"journal-article","created":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T16:32:23Z","timestamp":1734366743000},"page":"188","source":"Crossref","is-referenced-by-count":8,"title":["External Validation of Brief Resolved Unexplained Events Prediction Rules for Serious Underlying Diagnosis"],"prefix":"10.1001","volume":"179","author":[{"given":"Nassr","family":"Nama","sequence":"first","affiliation":[{"name":"Division of Hospital Medicine, Department of Pediatrics, University of Washington, Seattle Children\u2019s Hospital, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ye","family":"Shen","sequence":"additional","affiliation":[{"name":"BC Children\u2019s Hospital Research Institute, Vancouver, British Columbia, 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