SAQ 370 – Paediatrics – brief resolved unexplained event
Model Answer
Paediatrics – brief resolved unexplained event.
a. BRUE criteria
- Occurs in an infant under 12 months.
- Duration less than 1 minute, typically 20-30 seconds.
- Return to baseline state.
- Not explained by another identifiable medical condition.
- Includes at least one of central cyanosis or pallor, absent/decreased/irregular breathing, marked change in tone, or altered level of consciousness.
b. Differentials
| Category | Specific example |
|---|---|
| Normal physiological response | Laryngospasm or gagging. |
| Inflicted injury | Shaken baby, intentional suffocation, drug overdose, or factitious illness by proxy. |
| Infection | Pertussis, septicaemia, pneumonia, or meningitis. |
| Airway obstruction | Congenital abnormality, infection, or hypotonia. |
| Abdominal | Intussusception, strangulated hernia, or testicular torsion. |
| Metabolic | Hypoglycaemia, hypocalcaemia, hypokalaemia, or inborn error of metabolism. |
| Cardiac | Congenital heart disease, arrhythmia, vascular ring, or prolonged QT. |
| Neurological/toxicological | Seizure, head injury, cerebral malformation, inhaled foreign body, or accidental/non-accidental drug exposure. |
c. Lower-risk BRUE
- No concerning features on history or examination.
- Age over 60 days.
- Born at 32 weeks gestation or more and corrected gestational age at least 45 weeks.
- No CPR by a trained healthcare professional.
- First event only.
- Event lasted under 1 minute.
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