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CalculatorsBRUE Classification — Brief Resolved Unexplained Event

PediatricCriteria

BRUE Classification — Brief Resolved Unexplained Event

Classifies infants presenting with a brief resolved unexplained event (BRUE) into lower-risk or higher-risk groups to guide appropriate evaluation and management. BRUE (formerly ALTE — apparent life-threatening event) criteria were updated by AAP in 2016. Lower-risk BRUE infants can be managed with a limited evaluation and avoid unnecessary investigations.

Parameters

Step 1: Confirm BRUE Criteria (ALL must be present)

Infant age ≤ 12 months at time of eventBRUE criteria only apply to infants 0–12 months of age.Event has fully resolved by time of evaluationNo ongoing abnormal findings when examined by clinician.No medical explanation found after thorough history and physical examNo GERD, infection, seizure, cardiac arrhythmia, metabolic disorder, or other identified cause.Observer described ≥ 1 BRUE featureCentral cyanosis or pallor; absent/decreased/irregular breathing; marked hypotonia or hypertonia; altered level of responsiveness.Episode was brief (< 1 minute — most episodes much shorter)Duration of the event itself was transient and self-limited.

Lower-Risk BRUE Criteria (ALL must be met for lower-risk classification)

Age ≥ 60 days at time of eventYounger infants at higher risk due to immature respiratory control.Gestational age ≥ 32 weeks AND corrected gestational age ≥ 45 weeksPremature infants with persistent corrected age below 45 weeks remain higher risk.First BRUE only (not recurrent)No prior BRUE episodes.CPR was not required by trained medical providerLayperson/parent intervention does not disqualify, but trained medical provider CPR suggests higher severity.No concerning family history (no sudden unexplained infant death in first-degree relative)Family history of sudden cardiac death, long QT, channelopathy, or SUID in sibling increases risk.No features concerning for child maltreatmentNo bruising, retinal hemorrhages, inconsistent history, unexplained injuries.

Higher-Risk Features (Any ONE = Higher-Risk BRUE Classification)

Age < 60 days (higher risk)Very young infants have higher risk of serious underlying cause.Gestational age < 32 weeks or corrected age < 45 weeks (higher risk)Prematurity increases BRUE recurrence and serious cause probability.CPR required by trained medical provider (higher risk)Provider-initiated CPR indicates higher severity event.Multiple BRUE events / clustering (higher risk)Prior BRUE history or cluster of events same day increases serious etiology probability.Family history of SUID or sudden cardiac death (higher risk)Hereditary channelopathy risk.Abnormal history or physical exam findings (higher risk)Any finding on exam or history that does not fit normal.

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