No Explanation Is the Only Explanation When It Comes to BRUE

Kevin McFarlane
Kevin McFarlane

Brief resolved unexplained events are not new to emergency departments, but the BRUE terminology is a recent addition to the ED vocabulary following a fresh look at the definition of apparent life-threatening events in 2016.

“BRUE is not a term that we hear a lot,” said Kevin McFarlane, a professional development specialist for a multi-hospital system in Texas. “ALTE was the terminology, and that changed. They’re trying to narrow the term because it’s not a specific diagnosis, it is a description.”

McFarlane, who also hosts the podcast “Art of Emergency Nursing,” will explain What To Do About a BRUE (Brief Resolved Unexplained Events) in a live stream session at Emergency Nursing 2021 – A Virtual Xperience from 11 to 11:45 a.m. Central time on Sept. 24. (schedule subject to change)

BRUE refers to the classic case of a caregiver, typically a parent, showing up at the ED reporting their infant turned blue, went limp or became stiff, had a change in respiratory effort or lost consciousness, but all symptoms are resolved by the time they arrive at the ED.

“What the emergency room nurse sees is a well-appearing baby whose vital signs are all normal,” McFarlane explained. “BRUE is used as a rule-out diagnosis. They would say, ‘OK, if we’ve ruled everything out, then this is what we call it.’”

With input from the audience, McFarlane will complete that process of elimination.

“We’re going to go system by system to make sure it’s not a cardiac anomaly, make sure it’s not a respiratory issue,” he said. “Once we’ve ruled out all the bad things, then we can hang this label on it. We can use this as a diagnosis of exclusion.”

Previously, such cases were classified as near-miss SIDS events.

“That terminology didn’t fit because these children may or may not have died without intervention,” McFarlane said. “Then the ALTE definition worked, and we used that for a while, but now with the BRUE terminology, they’ve narrowed it down to a very specific age group under 1 year old.”

McFarlane began his career as a pediatric ED nurse, and one of the first calls he remembers was a BRUE. A baby went limp and turned pale at home. By the time the child’s mother brought her to the ED, she was awake and alert with a healthy skin tone. The puzzling experience inspired McFarlane to learn more.

“It was just interesting the whole idea that there would be a patient who would have such dramatic symptomatology, but by the time they came to us, it was nothing,” he said.

As an emergency nurse, it’s easy to dismiss a BRUE as a case of a first-time parent panicking or misinterpreting what is happening.

“It’s important to take these seriously and make sure that we believe the patient, we believe the family when they say that these unusual things happen,” McFarlane said. “Just because we weren’t there and it doesn’t match the picture we’re seeing now, it doesn’t mean it didn’t happen.”

A recording of this session will be available for on-demand viewing through Jan. 31.