Risk of Death in Infants Who Have Experienced a Brief Resolved Unexplained Event: A Meta-Analysis

Donald A. Brand, Melissa J. Fazzari

Research output: Contribution to journalArticle

7 Scopus citations


Objective: To estimate an upper bound on the risk of death after a brief resolved unexplained event (BRUE), a sudden alteration in an infant's breathing, color, tone, or responsiveness, previously labeled “apparent life-threatening event” (ALTE). Study design: The meta-analysis incorporated observational studies of patients with ALTE that included data on in-hospital and post-discharge deaths with at least 1 week of follow-up after hospital discharge. Pertinent studies were identified from a published review of the literature from 1970 through 2014 and a supplementary PubMed query through February 2017. Results: The 12 included studies (n = 3005) reported 12 deaths, of which 8 occurred within 4 months of the event. Applying a Poisson-normal random effects model to the 8 proximate deaths using a 4-month time horizon yielded a post-ALTE mortality rate of about 1 in 800, which constitutes an upper bound on the risk of death after a BRUE. Conclusions: This risk is about the same as the baseline risk of death during the first year of life. The meta-analysis therefore supports the return-home approach advocated in a recently published clinical practice guideline—not routine hospitalization—for BRUE patients who have been evaluated in the emergency department and determined to be at lower risk.

Original languageEnglish (US)
Pages (from-to)63-67
Number of pages5
JournalJournal of Pediatrics
StatePublished - Jun 2018
Externally publishedYes



  • ALTE
  • apparent life-threatening event
  • BRUE
  • emergency medicine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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