BRUE Lower-Risk Criteria (Brief Resolved Unexplained Event)
The American Academy of Pediatrics lower-risk criteria for a Brief Resolved Unexplained Event (Tieder and colleagues 2016).
Open the calculator → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Does the event meet the BRUE definition
- Yes
- Age over 60 days
- Yes
- Gestational age 32 weeks or more AND postconceptional age 45 weeks or more
- Yes
- Only one BRUE
- Yes
- Duration under 1 minute
- Yes
- No CPR by a trained medical provider was required
- Yes
- No concerning historical features
- Yes
- No concerning physical examination findings
- Yes
Result: BRUE, lower-risk.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Definition
- Infant under 1 year, sudden brief now-resolved episode of cyanosis or pallor, abnormal breathing, marked tone change, or altered responsiveness, with no explanation found.
- Exclusion
- A diagnosis of exclusion. If the history or exam explains the episode, it is that diagnosis and the criteria do not apply.
- All seven
- Age over 60 days; gestational age 32 weeks or more and postconceptional 45 weeks or more; single event; under 1 minute; no CPR by a provider; no concerning history; no concerning exam.
- Conjunctive
- Failing any one criterion is higher-risk by definition. There is no score and no partial credit.
- Lower-risk
- Not no risk and not a discharge order. Shared decision-making with the family is part of the guideline.
What you enter
- Does the event meet the BRUE definition - sudden, brief, now resolved, with a qualifying feature, and NO explanation identified after an appropriate history and physical examination?
- Age over 60 days.
- Gestational age 32 weeks or more AND postconceptional age 45 weeks or more.
- Only one BRUE: no prior BRUE ever, and not occurring in clusters.
- Duration under 1 minute.
- No CPR by a trained medical provider was required.
- No concerning historical features.
- No concerning physical examination findings.
Full field descriptions
- Does the event meet the BRUE definition - sudden, brief, now resolved, with a qualifying feature, and NO explanation identified after an appropriate history and physical examination? This is a gate: answer no and nothing further is scored, because BRUE is a diagnosis of exclusion.
- Age over 60 days. Required only when the event qualifies as a BRUE. All seven are conjunctive: failing this one alone makes the infant higher-risk.
- Gestational age 32 weeks or more AND postconceptional age 45 weeks or more. Stated as at-or-above. Published renderings diverge here: three say "or more", two say "over". At or above matches the guideline’s rationale, which attributes risk to birth below 32 weeks, attenuating once 45 weeks postconceptional age is reached. Required only when the event qualifies as a BRUE. All seven are conjunctive: failing this one alone makes the infant higher-risk.
- Only one BRUE: no prior BRUE ever, and not occurring in clusters. Required only when the event qualifies as a BRUE. All seven are conjunctive: failing this one alone makes the infant higher-risk.
- Duration under 1 minute. Required only when the event qualifies as a BRUE. All seven are conjunctive: failing this one alone makes the infant higher-risk.
- No CPR by a trained medical provider was required. Required only when the event qualifies as a BRUE. All seven are conjunctive: failing this one alone makes the infant higher-risk.
- No concerning historical features. Required only when the event qualifies as a BRUE. All seven are conjunctive: failing this one alone makes the infant higher-risk.
- No concerning physical examination findings. Required only when the event qualifies as a BRUE. All seven are conjunctive: failing this one alone makes the infant higher-risk.
How this is calculated
Tieder JS, Bonkowsky JL, Etzel RA, et al. Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. Pediatrics. 2016;137(5):e20160590. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.