P4A157: Interfacility Transfers for Brief Resolved Unexplained Events and Their Outcomes

Background: A brief resolved unexplained event (BRUE) is a common yet challenging presentation. The inability to predict recurrence and/or serious underlying conditions often prompts transfer from general emergency departments (ED) to a pediatric facility for definitive care. Our objective was to evaluate the outcomes of interfacility transfers for BRUE and determine the occurrence of a serious underlying diagnosis that may explain the index event.

Methods: We performed a retrospective chart review of infants < 1 year of age transferred to our tertiary care children’s hospital for BRUE from January 1, 2020, to September 30, 2022. Transfers from primary care offices, urgent care centers, or our satellite pediatric emergency department (PED) and patients with known predisposing conditions or comorbidities were excluded. We abstracted demographic information, type of transferring facility, investigations performed, and discharge diagnosis. The probable or definite diagnosis that explained the event was classified as non-serious and serious (a condition for which a delay in diagnosis or treatment could potentially increase morbidity or mortality). We reviewed return visits in our electronic medical records for all patients up to 1 year of age for any BRUE-related event or documentation of a serious diagnosis.

Results: Seventy four patients met study’s eligibility criteria. The majority were female (52.7%), < 2 months of age (77.0%), transferred from an academic ED (82.4%) and directly admitted (62.2%). Less than a quarter (23.0%) had a history of prematurity. More than one-third (39.3%) were discharged from the PED. Nearly two-thirds (66.2%) of patients underwent workup at our hospital, most commonly for seizures (Figure 1). None of the additional workup was contributory. Nearly one-fifth (20.2%) of the patients had a follow-up visit with a subspecialist post discharge. Only two patients had a return visit for another episode of BRUE. For the majority (60.8%) a probable or definite non-serious underlying condition explained the index event (Table 1). A serious underlying diagnosis was made only in four patients (Index visit: seizure-2; hypoventilation syndrome-1; subspecialist follow-up visit: suspected metabolic disorder).

Conclusion: Interfacility transfers for BRUE are associated with good outcomes. Though, more than half had a benign explanation for the event, majority was directly admitted and underwent workup with low yield. Targeted efforts are needed to enhance physician familiarity adherence to AAP guidelines for BRUE to reduce low value transfers and optimize resource utilization.