When managing an infant aged >60 d and <1 y and who, on the basis of a thorough history and physical examination, meets criteria for having experienced a lower-risk BRUE, clinicians: . | Evidence Quality; Strength of Recommendation . |
---|---|
1. Cardiopulmonary evaluation | |
1A. Need not admit infants to the hospital solely for cardiorespiratory monitoring. | B; Weak |
1B. May briefly monitor patients with continuous pulse oximetry and serial observations. | D; Weak |
1C. Should not obtain a chest radiograph. | B; Moderate |
1D. Should not obtain a measurement of venous or arterial blood gas. | B; Moderate |
1E. Should not obtain an overnight polysomnograph. | B; Moderate |
1F. May obtain a 12-lead electrocardiogram. | C; Weak |
1G. Should not obtain an echocardiogram. | C; Moderate |
1H. Should not initiate home cardiorespiratory monitoring. | B; Moderate |
2. Child abuse evaluation | |
2A. Need not obtain neuroimaging (CT, MRI, or ultrasonography) to detect child abuse. | C; Weak |
2B. Should obtain an assessment of social risk factors to detect child abuse. | C; Moderate |
3. Neurologic evaluation | |
3A. Should not obtain neuroimaging (CT, MRI, or ultrasonography) to detect neurologic disorders. | C; Moderate |
3B. Should not obtain an EEG to detect neurologic disorders. | C; Moderate |
3C. Should not prescribe antiepileptic medications for potential neurologic disorders. | C; Moderate |
4. Infectious disease evaluation | |
4A. Should not obtain a WBC count, blood culture, or cerebrospinal fluid analysis or culture to detect an occult bacterial infection. | B; Strong |
4B. Need not obtain a urinalysis (bag or catheter). | C; Weak |
4C. Should not obtain chest radiograph to assess for pulmonary infection. | B; Moderate |
4D. Need not obtain respiratory viral testing if rapid testing is available. | C; Weak |
4E. May obtain testing for pertussis. | B; Weak |
5. Gastrointestinal evaluation | |
5A. Should not obtain investigations for GER (eg, upper gastrointestinal tract series, pH probe, endoscopy, barium contrast study, nuclear scintigraphy, and ultrasonography). | C; Moderate |
5B. Should not prescribe acid suppression therapy. | C; Moderate |
6. IEM evaluation | |
6A. Need not obtain measurement of serum lactic acid or serum bicarbonate. | C; Weak |
6B. Should not obtain a measurement of serum sodium, potassium, chloride, blood urea nitrogen, creatinine, calcium, or ammonia. | C; Moderate |
6C. Should not obtain a measurement of venous or arterial blood gases. | C; Moderate |
6D. Need not obtain a measurement of blood glucose. | C; Weak |
6E. Should not obtain a measurement of urine organic acids, plasma amino acids, or plasma acylcarnitines. | C; Moderate |
7. Anemia evaluation | |
7A. Should not obtain laboratory evaluation for anemia. | C; Moderate |
8. Patient- and family-centered care | |
8A. Should offer resources for CPR training to caregiver. | C; Moderate |
8B. Should educate caregivers about BRUEs. | C; Moderate |
8C. Should use shared decision-making. | C; Moderate |
When managing an infant aged >60 d and <1 y and who, on the basis of a thorough history and physical examination, meets criteria for having experienced a lower-risk BRUE, clinicians: . | Evidence Quality; Strength of Recommendation . |
---|---|
1. Cardiopulmonary evaluation | |
1A. Need not admit infants to the hospital solely for cardiorespiratory monitoring. | B; Weak |
1B. May briefly monitor patients with continuous pulse oximetry and serial observations. | D; Weak |
1C. Should not obtain a chest radiograph. | B; Moderate |
1D. Should not obtain a measurement of venous or arterial blood gas. | B; Moderate |
1E. Should not obtain an overnight polysomnograph. | B; Moderate |
1F. May obtain a 12-lead electrocardiogram. | C; Weak |
1G. Should not obtain an echocardiogram. | C; Moderate |
1H. Should not initiate home cardiorespiratory monitoring. | B; Moderate |
2. Child abuse evaluation | |
2A. Need not obtain neuroimaging (CT, MRI, or ultrasonography) to detect child abuse. | C; Weak |
2B. Should obtain an assessment of social risk factors to detect child abuse. | C; Moderate |
3. Neurologic evaluation | |
3A. Should not obtain neuroimaging (CT, MRI, or ultrasonography) to detect neurologic disorders. | C; Moderate |
3B. Should not obtain an EEG to detect neurologic disorders. | C; Moderate |
3C. Should not prescribe antiepileptic medications for potential neurologic disorders. | C; Moderate |
4. Infectious disease evaluation | |
4A. Should not obtain a WBC count, blood culture, or cerebrospinal fluid analysis or culture to detect an occult bacterial infection. | B; Strong |
4B. Need not obtain a urinalysis (bag or catheter). | C; Weak |
4C. Should not obtain chest radiograph to assess for pulmonary infection. | B; Moderate |
4D. Need not obtain respiratory viral testing if rapid testing is available. | C; Weak |
4E. May obtain testing for pertussis. | B; Weak |
5. Gastrointestinal evaluation | |
5A. Should not obtain investigations for GER (eg, upper gastrointestinal tract series, pH probe, endoscopy, barium contrast study, nuclear scintigraphy, and ultrasonography). | C; Moderate |
5B. Should not prescribe acid suppression therapy. | C; Moderate |
6. IEM evaluation | |
6A. Need not obtain measurement of serum lactic acid or serum bicarbonate. | C; Weak |
6B. Should not obtain a measurement of serum sodium, potassium, chloride, blood urea nitrogen, creatinine, calcium, or ammonia. | C; Moderate |
6C. Should not obtain a measurement of venous or arterial blood gases. | C; Moderate |
6D. Need not obtain a measurement of blood glucose. | C; Weak |
6E. Should not obtain a measurement of urine organic acids, plasma amino acids, or plasma acylcarnitines. | C; Moderate |
7. Anemia evaluation | |
7A. Should not obtain laboratory evaluation for anemia. | C; Moderate |
8. Patient- and family-centered care | |
8A. Should offer resources for CPR training to caregiver. | C; Moderate |
8B. Should educate caregivers about BRUEs. | C; Moderate |
8C. Should use shared decision-making. | C; Moderate |
CPR, cardiopulmonary resuscitation; CT, computed tomography; GER, gastroesophageal reflux; WBC, white blood cell.