{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T05:51:09Z","timestamp":1791611469205,"version":"4.3.4"},"reference-count":26,"publisher":"American Academy of Pediatrics (AAP)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVE<\/jats:title><jats:p>The objective with this study was to describe pediatric emergency department (ED) physicians\u2019 perspective on the evaluation and management of brief resolved unexplained events (BRUEs) to help support the development of quality improvement interventions for this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We conducted qualitative semistructured interviews with pediatric ED providers who practice in a single state. Interviews were audio-recorded and transcribed and demographic information was also obtained. The 6-phase approach to reflexive thematic analysis was used to conduct the qualitative analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Nineteen pediatric ED physicians practicing in 4 institutions across our state participated in the study. The majority of participants (95%) practice in a university-affiliated setting. The primary themes related to providing care for patients with a BRUE identified in our analysis were (1) reassurance, (2) caregiver or provider concern, and (3) clinical practice guideline availability and interpretation. Closely intertwined underlying topics informing BRUE patient management were also noted: (1) ambiguity in the BRUE diagnosis and its management; (2) a need for shared decision-making between the caregiver and the provider; and (3) concern over the increased time spent with caregivers during an ED visit for a diagnosis of BRUE. These complex relationships were found to influence patient evaluation and disposition.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p>Multifaceted quality improvement interventions should address caregiver and provider concerns regarding the diagnosis of BRUE while providing decision aids to support shared decision-making with caregivers.<\/jats:p><\/jats:sec>","DOI":"10.1542\/hpeds.2021-005805","type":"journal-article","created":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T09:26:29Z","timestamp":1630488389000},"page":"996-1003","source":"Crossref","is-referenced-by-count":10,"title":["Pediatrician Perspectives on Brief Resolved Unexplained Events"],"prefix":"10.1542","volume":"11","author":[{"given":"Karolina","family":"Maksimowski","sequence":"first","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Haddad","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy M.","family":"DeLaroche","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics, Children\u2019s Hospital of Michigan, Detroit, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"issue":"5","key":"2021121007573047400_b1","doi-asserted-by":"crossref","first-page":"e20160590","DOI":"10.1542\/peds.2016-0590","article-title":"Brief resolved unexplained events (formerly apparent life-threatening events) and evaluation of lower-risk infants","volume":"137","author":"Tieder","year":"2016","journal-title":"Pediatrics"},{"issue":"5","key":"2021121007573047400_b2","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.jpeds.2007.11.024","article-title":"Variation in inpatient resource utilization and management of apparent life-threatening events","volume":"152","author":"Tieder","year":"2008","journal-title":"J Pediatr"},{"issue":"4","key":"2021121007573047400_b3","doi-asserted-by":"crossref","first-page":"e20190375","DOI":"10.1542\/peds.2019-0375","article-title":"Changes in the management of children with brief resolved unexplained events (BRUEs)","volume":"144","author":"Ramgopal","year":"2019","journal-title":"Pediatrics"},{"issue":"1","key":"2021121007573047400_b4","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.annemergmed.2007.04.009","article-title":"Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report","volume":"51","author":"Wright","year":"2008","journal-title":"Ann Emerg Med"},{"issue":"2","key":"2021121007573047400_b5","doi-asserted-by":"crossref","first-page":"e20184101","DOI":"10.1542\/peds.2018-4101","article-title":"A framework for evaluation of the higher-risk infant after a brief resolved unexplained event","volume":"144","author":"Merritt","year":"2019","journal-title":"Pediatrics"},{"issue":"4","key":"2021121007573047400_b6","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1542\/hpeds.2019-0195","article-title":"Outcome prediction of higher-risk brief resolved unexplained events","volume":"10","author":"DeLaroche","year":"2020","journal-title":"Hosp Pediatr"},{"issue":"7","key":"2021121007573047400_b7","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1542\/hpeds.2018-0220","article-title":"Caregivers\u2019 perceptions and hospital experience after a brief resolved unexplained event: a qualitative study","volume":"9","author":"Khan","year":"2019","journal-title":"Hosp Pediatr"},{"issue":"5","key":"2021121007573047400_b8","doi-asserted-by":"crossref","first-page":"e243","DOI":"10.1097\/PEC.0000000000001659","article-title":"Implementing the 2016 American Academy of Pediatrics guideline on brief resolved unexplained events: the parent\u2019s perspective","volume":"37","author":"Brand","year":"2021","journal-title":"Pediatr Emerg Care"},{"key":"2021121007573047400_b9","unstructured":"Electronic Residency Application Service\u2013Association of American Medical Colleges. Pediatric emergency medicine (emergency medicine). Available at: https:\/\/services.aamc.org\/eras\/erasstats\/par\/display.cfm?NAV_ROW=PAR&SPEC_CD=114. Accessed March 5, 2021"},{"issue":"2","key":"2021121007573047400_b10","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"issue":"3","key":"2021121007573047400_b11","article-title":"Doing a thematic analysis: a practical step-by-step guide for learning and teaching scholars","volume":"9","author":"Maguire","year":"2017","journal-title":"AISHE-J"},{"key":"2021121007573047400_b12","unstructured":"Ryan\u2008GW, Bernard\u2008HR. Techniques to identify themes in qualitative data. Available at: www.analytictech.com\/mb870\/Readings\/ryan-bernard_ techniques_to_identify_themes_in.htm. Accessed May 5, 2021"},{"issue":"5","key":"2021121007573047400_b13","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1188\/14.ONF.545-547","article-title":"The use of triangulation in qualitative research","volume":"41","author":"Carter","year":"2014","journal-title":"Oncol Nurs Forum"},{"issue":"1","key":"2021121007573047400_b14","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s11606-017-4164-1","article-title":"Defining and measuring diagnostic uncertainty in medicine: a systematic review","volume":"33","author":"Bhise","year":"2018","journal-title":"J Gen Intern Med"},{"issue":"1","key":"2021121007573047400_b15","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1093\/intqhc\/mzx170","article-title":"Patient perspectives on how physicians communicate diagnostic uncertainty: an experimental vignette study","volume":"30","author":"Bhise","year":"2018","journal-title":"Int J Qual Health Care"},{"key":"2021121007573047400_b16","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2020-036095","article-title":"Risk factors and outcomes after a brief resolved unexplained event: a multicenter study [published online ahead of print June 24, 2021]","author":"Tieder","year":"2021","journal-title":"Pediatrics"},{"issue":"12","key":"2021121007573047400_b17","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1111\/acem.13043","article-title":"The physician-as-stakeholder: an exploratory qualitative analysis of physicians\u2019 motivations for using shared decision making in the emergency department","volume":"23","author":"Schoenfeld","year":"2016","journal-title":"Acad Emerg Med"},{"issue":"3","key":"2021121007573047400_b18","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1016\/j.pec.2008.07.018","article-title":"Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals\u2019 perceptions","volume":"73","author":"L\u00e9gar\u00e9","year":"2008","journal-title":"Patient Educ Couns"},{"issue":"6","key":"2021121007573047400_b19","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1136\/emermed-2018-208242","article-title":"Physician-identified barriers to and facilitators of shared decision-making in the Emergency Department: an exploratory analysis","volume":"36","author":"Schoenfeld","year":"2019","journal-title":"Emerg Med J"},{"issue":"1","key":"2021121007573047400_b20","first-page":"CD001431","article-title":"Decision aids for people facing health treatment or screening decisions","volume":"1","author":"Stacey","year":"2014","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"2021121007573047400_b21","doi-asserted-by":"crossref","first-page":"e182430","DOI":"10.1001\/jamanetworkopen.2018.2430","article-title":"Effect of the head computed tomography choice decision aid in parents of children with minor head trauma: a cluster randomized trial","volume":"1","author":"Hess","year":"2018","journal-title":"JAMA Netw Open"},{"key":"2021121007573047400_b22","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1007\/s40746-015-0028-2","article-title":"Change management in quality improvement: the softer skills","volume":"1","author":"Hart","year":"2015","journal-title":"Curr Treat Options Pediatr"},{"key":"2021121007573047400_b23","article-title":"Tools and strategies for quality improvement and patient safety","volume-title":"Patient Safety and Quality: An Evidence-Based Handbook for Nurses","author":"Hughes","year":"2008"},{"key":"2021121007573047400_b24","unstructured":"Institute for Healthcare Improvement. Using change concepts for improvement. Available at: www.ihi.org\/resources\/Pages\/Changes\/UsingChangeConceptsfor Improvement.aspx. Accessed March 5, 2021"},{"issue":"5","key":"2021121007573047400_b25","doi-asserted-by":"crossref","first-page":"e20182459","DOI":"10.1542\/peds.2018-2459","article-title":"Pediatric readiness in the emergency department","volume":"142","author":"Remick","year":"2018","journal-title":"Pediatrics"},{"issue":"5","key":"2021121007573047400_b26","doi-asserted-by":"crossref","first-page":"e0232076","DOI":"10.1371\/journal.pone.0232076","article-title":"A simple method to assess and report thematic saturation in qualitative research","volume":"15","author":"Guest","year":"2020","journal-title":"PLoS One"}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/11\/9\/996\/1153152\/hpeds_2021-005805.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/11\/9\/996\/1153152\/hpeds_2021-005805.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,8]],"date-time":"2023-11-08T03:58:46Z","timestamp":1699415926000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/11\/9\/996\/180049\/Pediatrician-Perspectives-on-Brief-Resolved"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,1]]},"references-count":26,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,1]]},"published-print":{"date-parts":[[2021,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2021-005805","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"value":"2154-1663","type":"print"},{"value":"2154-1671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,1]]}}}