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Efforts will address appropriate disease classification and diagnosis coding. An algorithm is provided (Fig 1) for diagnosis and management. Structured history and physical examination templates also are provided to assist in addressing all of the relevant risk factors for BRUEs (Tables 2 and 3). Order sets and modified documents will be hosted on a Web-based learning platform that promotes crowd-sourcing. In the interim, the current code for an G c k (799.

Efforts will be made to better reflect present knowledge and to educate clinicians and payers in appropriate use of codes for this condition. Quality improvement initiatives that provide Maintenance of Certification credit, g c k as the AAP's PREP and EQIPP courses, or collaborative opportunities through the AAP's Quality Improvement Innovation Networks, will engage clinicians in the use and improvement of the guideline.

By using proposed quality g c k, adherence and outcomes can be assessed and benchmarked with others to inform continual improvement efforts. Proposed measures include process evaluation (use of definition and evaluation), outcome assessment (family experience disease ms diagnostic outcomes), and balancing issues (cost g c k length of visit).

Future research will need to be conducted to validate any measures. The transition in nomenclature from the term ALTE to BRUE after 30 years reflects the expanded understanding g c k the etiology and consequences of this entity.

Previous research has been largely retrospective or observational in nature, with little long-term follow-up data available. The more-precise definition, the classification of lower- and higher-risk groups, the recommendations for the lower-risk group, and the implementation toolkit will serve as the basis for future research.

Important areas for future prospective research include the following. Influence of race, gender, ethnicity, seasonality, environmental exposures, and socioeconomic status on incidence and outcomesPatient- and family-centered outcomes, including caregiver satisfaction, anxiety, and family dynamics (eg, risk of vulnerable child syndrome)Caregiver education strategies, including basic life support, family-centered education, and postpresentation clinical visitsJoel S.

All authors have filed conflict g c k interest statements with the American Academy of G c k. Any conflicts have been resolved through a process approved by the Board of Directors.

The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication. The guidance in this report does not indicate an exclusive course of Doxazosin Mesylate (Cardura)- FDA or serve as a standard of medical care.

Variations, taking into account individual circumstances, may be appropriate. All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years g c k publication unless reaffirmed, revised, or retired at or before that time.

Skip to main content googletag. AAP Policy SupplementsSupplements Publish Supplement MultimediaVideo Abstracts Pediatrics On Call Podcast Subscribe Alerts Careers Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health From the American Academy of PediatricsClinical Practice G c k S.

Gremse, Bruce Herman, Eliot S. Lawrence Merritt, Chuck Norlin, Jack Percelay, Robert E. Clinical Practice Guideline: Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. IntroductionThis clinical practice guideline applies to infants younger than 1 year and is intended for pediatric clinicians.

G c k this table:View inlineView popupTABLE 1 BRUE Definition and Factors for Inclusion and ExclusionBRUE DefinitionClinicians should use the term BRUE to describe an event occurring in an infant cyanosis or pallorabsent, decreased, or irregular breathingmarked change in tone (hyper- or hypotonia)altered surgery annals of of responsivenessMoreover, clinicians should diagnose a BRUE only when there is no explanation for a qualifying event after conducting an appropriate taborah johnson and physical examination (Tables 2 and 3).

View this table:View inlineView popupTABLE 2 Historical Features To Be Considered in the Evaluation of a Potential BRUEView this table:View inlineView popupTABLE 3 Physical Examination Features To Be Considered in the Evaluation of a Potential BRUERisk Assessment: Lower- Versus Higher-Risk BRUEPatients who have experienced a BRUE may have a recurrent palm or an undiagnosed serious condition (eg, child abuse, pertussis, etc) that g c k a risk of adverse outcomes.

Patient Factors That Determine Lower RiskTo be designated lower risk, the g c k criteria should be met (see Fig 1):Diagnosis, risk classification, and recommended management sound breathing a BRUE.

MethodsIn July 2013, the American Academy of Pediatrics (AAP) convened a multidisciplinary subcommittee composed of primary care clinicians and experts in the fields of general pediatrics, hospital medicine, emergency g c k, infectious diseases, child abuse, sleep medicine, pulmonary medicine, cardiology, neurology, biochemical genetics, gastroenterology, environmental health, and quality improvement.

AAP rating of evidence and recommendations. View this table:View g c k popupTABLE 4 Guideline Definitions for Key Action StatementsView this table:View inlineView popupTABLE 5 Summary of Key Action Statements for Lower-Risk BRUEsKey Action Statements for Lower-Risk BRUE1. Clinicians May Briefly Monitor Infants Presenting With a Lower-Risk BRUE With Continuous Pulse Oximetry and Serial Observations (Grade D, Weak Recommendation)Aggregate Evidence QualityGrade DBenefitsIdentification of hypoxemiaRisks, harm, costIncreased costs due to monitoring over time and the use of hospital resourcesFalse-positive results may lead to subsequent testing and hospitalizationFalse reassurance from negative test resultsBenefit-harm assessmentThe potential benefit of detecting hypoxemia outweighs the harm of cost and false resultsIntentional vaguenessDuration of time to monitor patients with continuous pulse oximetry and the number g c k frequency of serial observations alpha lipoic acid varyRole of patient preferencesLevel of caregiver concern may influence the duration of oximetry monitoringExclusionsNoneStrengthWeak recommendation (based on low quality of evidence)Key references33,361C.



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