Improving the Care and Science of BRUE: Learning from a National Research and Quality Improvement Collaboration.

Sunday, April 30, 2023

11:00 AM – 12:30 PM ET

Location: Convention Center: 201

CE: Live CME: 1.50

Selected By: EM
Co-sponsored By: PHM

Chair(s)

Joel Tieder, MD. MPH (he/him/his)

Professor of Pediatrics
Seattle Children's and the University of WA
Seattle, Washington, United States
Nassr Nama, MD, MSc, FAAP (he/him/his)

Clinical Assistant Professor
Seattle Children's Hospital
Seattle, Washington, United States

Disclosure(s):

Joel Tieder, MD. MPH: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Nassr Nama, MD, MSc, FAAP: No financial relationships to disclose

Session

Description: Brief Resolved Unexplained Events (BRUE) are common among infants. Most often, they are benign and self-limited. Rarely they can be an index presentation of a more serious diagnosis. Risk stratification of these infants and management of those with higher-risk features have been challenging, due to the heterogeneity of identified diagnoses. As such, most diagnostic tests and consultations’ yield is low, and a multidisciplinary collaborative approach is required to manage BRUE. Emergency physicians, hospitalists, and consultants (gastroenterologists and neurologists) are commonly involved in evaluating these patients.

Similarly, a multidisciplinary collaborative framework is needed to improve the clinical care of this population. In this session, we will demonstrate our approach to advancing our understanding of BRUE, through the development of a clinical practice guideline and a multidisciplinary collaboration with research and quality improvement aims. We will present the key findings from this collaboration and how to translate these findings into clinical practice.

Participants will appraise new risk-stratification tools and how to incorporate them into a shared-decision making model. Next, we will review the management of patients with BRUE in the Emergency Department, focusing on the yield of hospital admission, specific diagnostic testing, and consultations. This will include a discussion of which patients may benefit from these measures. Finally, we will examine in more detail two systems most implicated in patients with an underlying disorder (neurology and gastroenterology).

We will then discuss lessons learned from this collaboration and provide recommendations for other disease entities that would benefit from a similar collaborative approach.

Learning Objectives:

Appraise the recent evidence related to the diagnosis and management of BRUE.
Formulate a shared-decision making approach in the management of BRUE, relying on a new evidence-based framework and incorporating interactive tools for risk assessment.
Describe key steps in designing multidisciplinary research and quality improvement collaborations.

Presentations:

11:00 AM – 11:20 AM ET

Research and Quality Improvement in BRUE: Establishing a Multidisciplinary Collaboration.
Speaker: Joel Tieder, MD. MPH (he/him/his) – Seattle Children's and the University of WA
11:20 AM – 11:35 AM ET

Risk Stratification: The Limits of the AAP Clinical Practice Guideline, and Development of a Shared-Decision Making Tool.
Speaker: Nassr Nama, MD, MSc, FAAP (he/him/his) – Seattle Children's Hospital
11:35 AM – 11:50 AM ET

Reassuring Parents and Identifying Serious Illness: The Yield of Hospital Admission, Diagnostic Testing, and Consultations.
Speaker: Amy DeLaroche, MBBS – Children's Hospital of Michigan
11:50 AM – 12:00 PM ET

BRUE, Seizures, and Abnormal Movement: Evaluation and Management from the Subspecialists' Perspective.
Speaker: Joshua L. Bonkowsky, MD, PhD (he/him/his) – Primary Children's Hospital; University of Utah
12:00 PM – 12:10 PM ET

BRUE, Aspiration, and Reflux: Evaluation and Management from the Subspecialists' Perspective.
Speaker: David Gremse, MD (he/him/his) – University of South Alabama