{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T05:50:45Z","timestamp":1791611445866,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using the Nationwide Emergency Department Sample for 2012\u20132019, we conducted a cross\u2010sectional study of children &lt;1\u2009year 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 (<jats:italic>p<\/jats:italic>\u2009=\u20090.19). BRUE ED incidence was 5.06 per 1000 infant ED encounters (<jats:italic>p<\/jats:italic>\u2009=\u20090.14). The impact of the BRUE CPG on admission rates was limited to pediatric EDs (level shift\u2009\u221223.3%, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Transfers from general EDs did not change with the CPG (level shift\u20092.2%, <jats:italic>p<\/jats:italic>\u2009=\u20090.17). After the CPG was published, ECGs increased by 13.7% in pediatric EDs (<jats:italic>p<\/jats:italic>\u2009=\u20090.005) but did not change in general EDs (level shift\u2009\u22120.2%, <jats:italic>p<\/jats:italic>\u2009=\u20090.82).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14881","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T11:50:13Z","timestamp":1709293813000},"page":"667-674","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Epidemiology of brief resolved unexplained events and impact of clinical practice guidelines in general and pediatric emergency departments"],"prefix":"10.1111","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0199-3599","authenticated-orcid":false,"given":"Nassr","family":"Nama","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine, Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5425-6771","authenticated-orcid":false,"given":"Amy M.","family":"DeLaroche","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics Children's Hospital of Michigan  Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Boston Children's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8717-0138","authenticated-orcid":false,"given":"Manoj K.","family":"Mittal","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce E.","family":"Herman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, School of Medicine University of Utah  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Hochreiter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Hospital Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron L.","family":"Kaplan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine, Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allayne","family":"Stephans","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hospital Medicine Rainbow Babies and Children's Hospital  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel S.","family":"Tieder","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Washington School of Medicine, Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-049933"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.79.2.292"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-0590"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021-052673"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14666"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2020-036095"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-0375"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2021-006427"},{"key":"e_1_2_9_10_1","unstructured":"National Pediatric Readiness Project.EMSC Innovation & Improvement Center. 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