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Implementing lower‐risk brief resolved unexplained events guideline reduces admissions in a modelled population
Author(s) -
Oglesbee Scott J.,
Roberts Melissa H.,
Sapién Robert E.
Publication year - 2020
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.13211
Subject(s) - medicine , confidence interval , guideline , odds ratio , imputation (statistics) , propensity score matching , population , cpg site , pediatrics , emergency medicine , missing data , statistics , environmental health , mathematics , pathology , biochemistry , gene expression , chemistry , dna methylation , gene
Rationale American Academy of Pediatrics released a clinical practice guideline (CPG) in 2016 recommending the term apparent life‐threatening events (ALTE) be replaced by brief resolved unexplained events (BRUE). The CPG provides recommendations for the clinical evaluation and management of infants with this condition based on the risk of a serious underlying disorder or repeat event. The lower‐risk CPG was applied to a modelled population, studying predictors of hospital admission, defined as length of stay (LOS) ≥ 24 hours. Methods An algorithm was derived using a Pediatric Emergency Care Applied Research Network database. Propensity score weighting, based on probability of following the CPG, determined the adjusted odds ratio (aOR) and 95% confidence interval (CI) of hospital admission. Multiple imputation allowed any missing data problems be addressed and a sensitivity analysis of database robustness. Results Applying the modelling algorithm, 3116 observations were identified, among whom 1974 (63.4%) the CPG was followed and 1142 (36.6%) not followed. The CPG was followed for 60.1% of infants staying ≥24 hours compared with 76.6% of infants staying <24 hours ( P < .001). After propensity score weighting and multiple imputation, the likelihood of hospital admission was significantly lower when the CPG was followed (aOR = 0.49; 95% CI, 0.39‐0.62, P < .001). Conclusions Results suggest that use of the CPG under strict conditions would lead to fewer hospital admissions among infants with a lower‐risk BRUE. Implementation of CPGs in modelled populations may help clinicians identify unanticipated factors and address these issues beforehand. We noted differences in care based on race, necessitating further investigation.