Routine testing adds little after BRUE

After a brief resolved unexplained event, serious illness is uncommon, death is rare, and routine testing usually adds little.
*Systematic review and meta-analysis of cohort studies; Level 2a.

Citation

Nama N, Liebert S, Abaji M, et al. Infant Outcomes, Risk Factors, and Diagnostic Yield After a Brief Resolved Unexplained Event: A Systematic Review and Meta-Analysis. JAMA Pediatrics. 2026;180(3):250-262. doi:10.1001/jamapediatrics.2025.5858

Background

Brief resolved unexplained events in infants often prompt testing and hospital care, despite limited evidence that broad testing improves outcomes. This review aimed to clarify prognosis, risk factors, and which tests are useful.

Patients

Infants younger than 12 months meeting 2016 American Academy of Pediatrics criteria. Studies were excluded if events were not clinically verified or could not be distinguished from other episodes.

Intervention

Assessment of clinical risk factors and common diagnostic tests after the event.

Control

Infants without the risk factor, or comparison with the overall tested group.

Outcome

Serious underlying diagnosis, recurrent event, 3-month death, and diagnostic test yield.

Follow-up Period

Up to 3 months for recurrence and death; serious diagnoses within 1 year.

Results

Finding Result
Serious diagnosis (primary) 6.0% (95% CI, 4.6%-7.9%)
Death within 3 months (primary) 1 per 1851 infants
Recurrent event 13.6% (95% CI, 11.1%-16.7%)
Higher-risk features for serious diagnosis Multiple events +3.7%; prematurity +2.6%; abnormal medical history +3.1%
Routine tests Metabolic panels 0% yield; electrocardiograms 0.2%; chest radiographs 0.4%
More selective test Brain wave testing yield 5.5%; number needed to test 18

CI = confidence interval.

Age 60 days or younger was not linked to serious diagnosis. Most studies were observational, not treatment trials.

Limitations

Most studies were retrospective, single-center, and from high-income countries. Test yield may be overestimated because clinicians selected which infants were tested.

Funding

Seattle Children’s Research Institute awards; no industry funding reported.

Clinical Application

Reassure most families and avoid routine testing; target evaluation to infants with multiple events, prematurity, or abnormal history.