Understanding Brief Resolved Unexplained Events (BRUE) in Infants: A Shift Towards Shared Decision Making

Dr. Jessica Nelson
New Update

Understanding Brief Resolved Unexplained Events (BRUE) in Infants: A Shift Towards Shared Decision Making

BRUE, or Brief Resolved Unexplained Event, is a term used to describe apnea episodes in infants, where no underlying cause can be found. Historically, these episodes have presented a significant challenge to healthcare providers, as they are difficult to diagnose and manage. However, in recent years, there has been a significant shift in the approach to BRUE, resulting in reductions in both healthcare utilization and hospitalization for these infants.

Understanding BRUE

BRUE is a term that was adopted in 2016 by a Clinical Practice Guideline (CPG) to describe apnea episodes in infants where there is no discernible cause. The term was adopted as part of an effort to identify low-risk infants who could safely be discharged from the emergency department. This move has resulted in significant reductions in healthcare utilization, as fewer infants are being admitted to the hospital for these events.

The Challenge of Risk Assessment

Despite the benefits of the BRUE classification, it has proven challenging to determine whether an infant is at low or high risk for a recurrence of BRUE. To address this issue, a 15-hospital collaborative study led to the development of the BRUE 2.0 criteria. This new set of criteria enables a more focused risk assessment of an infant who has experienced a BRUE.

The Role of Shared Decision Making

The approach to managing BRUE has evolved over time. With the likelihood of identifying a serious diagnosis being low for most children, the approach to BRUE has moved into the realm of shared decision-making with families. This involves healthcare providers working closely with families to make decisions about their child's care. By taking into account the family's values, preferences and circumstances, shared decision-making can lead to better outcomes for infants experiencing BRUE.

Reducing Testing and Hospitalization

The adoption of shared decision-making and the BRUE 2.0 criteria has led to a reduction in testing and hospitalization for infants experiencing BRUE. By focusing on risk assessment and working closely with families, healthcare providers are able to avoid unnecessary tests and hospital stays. This not only reduces healthcare utilization, but also minimizes the stress and disruption to the family.


The management of BRUE in infants has significantly evolved over the years. With the introduction of the BRUE 2.0 criteria and the shift towards shared decision-making with families, there has been a reduction in healthcare utilization and hospitalization. This approach not only benefits the healthcare system but also results in better outcomes for infants and their families. As the field continues to evolve, it is hoped that further improvements can be made to the management and understanding of BRUE.