Learn about Brief Resolved Unexplained Event (BRUE) diagnosis, formerly known as Apparent Life-Threatening Event (ALTE). This guide covers BRUE clinical documentation, medical coding, and healthcare best practices for diagnosis and management. Find information on BRUE symptoms, evaluation, and when to consider ALTE as a possible diagnosis. Understand the key differences between BRUE and ALTE for accurate clinical documentation and appropriate medical coding.
Also known as
Brief resolved unexplained event (BRUE)
Brief episode of apnea, color change, change in muscle tone, choking or gagging.
Other specified abnormalities of breathing
Includes other breathing abnormalities like tachypnea or bradypnea, if related to BRUE.
Collapse, unspecified
May be used if BRUE involved a sudden loss of muscle tone and postural control.
Follow this step-by-step guide to choose the correct ICD-10 code.
Age < 1 year?
Yes
Event resolved?
No
Do not code BRUE. Consider other diagnoses based on symptoms.
When to use each related code
| Description |
|---|
| Brief resolved episode of concerning breathing changes, color change, or muscle tone. |
| Sudden, unexpected death of an infant <1 year, unexplained after investigation. |
| Seizure due to abnormal electrical activity in the brain. |
BRUE diagnosis often overlaps with premature infants' conditions, potentially leading to incorrect coding if not carefully documented.
Using the older term ALTE instead of BRUE might lead to overcoding and inaccurate severity reflection.
Failure to code the underlying cause, if identified, along with BRUE can lead to incomplete clinical picture and reimbursement issues.
Q: How do I differentiate a Brief Resolved Unexplained Event (BRUE) from a more serious condition in infants presenting with cyanosis or apnea?
A: Differentiating a BRUE (previously known as ALTE or Apparent Life-Threatening Event) from more serious conditions requires a thorough clinical evaluation. Key factors include a detailed history, focusing on the event's duration (less than one minute for BRUE), complete resolution, and absence of concerning features like fever, respiratory distress outside the event, or abnormal physical exam findings. Consider implementing standardized diagnostic protocols to assess for underlying cardiac, respiratory, gastrointestinal, metabolic, and neurologic conditions. For example, a thorough cardiac workup might be indicated if there's a family history of sudden cardiac death or if the infant experiences recurrent BRUEs. Explore how incorporating risk stratification tools can aid in decision-making regarding further investigations and hospital admission. While BRUE is typically benign, ruling out other potentially life-threatening conditions is paramount.
Q: What are the current best practice guidelines for managing a BRUE (Brief Resolved Unexplained Event) in a previously healthy infant?
A: Managing a BRUE in a previously healthy infant focuses on thorough history-taking, a comprehensive physical examination, and observation. Current guidelines, such as those from the American Academy of Pediatrics, emphasize shared decision-making with the family. While routine extensive testing is typically not recommended for low-risk BRUE, consider implementing individualized risk stratification based on factors like the infant's age, prematurity status, and specific event characteristics. Learn more about the updated BRUE guidelines and how they impact the evaluation and management of infants presenting with these events. Education and reassurance for caregivers are essential, addressing anxieties about recurrence and providing guidance on CPR and safe infant care practices. In certain situations, such as concerning features during the event or a history suggestive of an underlying condition, further investigations may be warranted.
Patient presented with a concerning episode characterized by symptoms consistent with a Brief Resolved Unexplained Event (BRUE), formerly known as an Apparent Life-Threatening Event (ALTE). The event was sudden and resolved spontaneously. Symptoms observed included [Document specific symptoms observed e.g., cyanosis, apnea, change in muscle tone, choking, gagging]. The episode lasted approximately [duration of episode]. The infant's age is [age of infant] and birth history is [note any relevant birth history, e.g., term, preterm, complications]. A thorough evaluation was performed to assess for potential underlying causes. Cardiopulmonary examination revealed [document findings e.g., normal heart rate and rhythm, clear lung sounds]. Oxygen saturation was [document SpO2 with method e.g., 99% on room air]. Neurological examination was [document findings e.g., normal tone and reflexes]. The infant's current vital signs are temperature [temperature], heart rate [heart rate], respiratory rate [respiratory rate], and blood pressure [blood pressure if obtained]. Family history was reviewed and is significant for [document pertinent family history e.g., no history of SIDS or seizure disorders]. Based on the clinical presentation and negative findings on initial workup, the diagnosis of BRUE is favored. Differential diagnoses considered include gastroesophageal reflux, seizure, breath-holding spell, and infection. Further investigations such as [list any planned tests e.g., ECG, EEG, laboratory studies] may be considered depending on the clinical course. Patient and family were educated on BRUE, its benign nature in most cases, and warning signs necessitating return to medical care. Close follow-up with the pediatrician is advised. ICD-10 code R68.13 is assigned for this encounter.