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Abstract：
To determine if hospitalization, testing, diagnosis, and management of suspected gastroesophageal reflux, and follow-up visits decreased since introduction of American Academy of Pediatrics guidelines for brief resolved unexplained events (BRUEs).
We performed a retrospective cohort study of infants with BRUE evaluated at Boston Children\'s Hospital in the year before and after guideline implementation to determine if practice patterns have changed. Outcomes included hospitalization rates, frequency of swallow assessments, other diagnostic testing, and reflux diagnoses, cost of care, and number of repeat visits. Groups were compared based on whether they presented before or after guideline implementation.
In total, 359 subjects (186 pre-, 173 post-guidelines) were identified. There were no significant differences in practice patterns or outcomes before or after guideline implementation. Subjects had mean age 2.53 ± 0.15 months, and 80% were hospitalized for 2.49 ± 0.26 days. Each subject had 2.47 diagnostic tests performed, and 89% were noncontributory. Despite only 13% having videofluoroscopic swallow study performed, 72% showed aspiration/penetration. No subject had gastroesophageal reflux testing, yet reflux was implicated as the cause for admission in 40% of subjects, resulting in increased odds of discharge on acid suppressing medications (OR 2.88, 95% CI 1.68-4.92, P = .0001). In follow-up, 28% of subjects had repeat hospitalizations or emergency department visits for persistent symptoms.
Infants with BRUE continue to undergo low-yield diagnostic testing and after admission remain symptomatic and frequently re-present to medical care. Swallow testing remains infrequent despite its high-yield, reflux continues to be implicated and children are still being discharged on acid suppression despite lack of efficacy.
We performed a retrospective cohort study of infants with BRUE evaluated at Boston Children\'s Hospital in the year before and after guideline implementation to determine if practice patterns have changed. Outcomes included hospitalization rates, frequency of swallow assessments, other diagnostic testing, and reflux diagnoses, cost of care, and number of repeat visits. Groups were compared based on whether they presented before or after guideline implementation.
In total, 359 subjects (186 pre-, 173 post-guidelines) were identified. There were no significant differences in practice patterns or outcomes before or after guideline implementation. Subjects had mean age 2.53 ± 0.15 months, and 80% were hospitalized for 2.49 ± 0.26 days. Each subject had 2.47 diagnostic tests performed, and 89% were noncontributory. Despite only 13% having videofluoroscopic swallow study performed, 72% showed aspiration/penetration. No subject had gastroesophageal reflux testing, yet reflux was implicated as the cause for admission in 40% of subjects, resulting in increased odds of discharge on acid suppressing medications (OR 2.88, 95% CI 1.68-4.92, P = .0001). In follow-up, 28% of subjects had repeat hospitalizations or emergency department visits for persistent symptoms.
Infants with BRUE continue to undergo low-yield diagnostic testing and after admission remain symptomatic and frequently re-present to medical care. Swallow testing remains infrequent despite its high-yield, reflux continues to be implicated and children are still being discharged on acid suppression despite lack of efficacy.
摘要：
为了确定是否住院，测试,诊断,以及疑似胃食管反流的处理，自美国儿科学会(AmericanAcademyofPediatrics)针对短暂解决的无法解释事件(BRUE)的指南出台以来,随访次数减少.
我们对波士顿儿童医院在指南实施前后一年内评估的BRUE婴儿进行了回顾性队列研究，以确定实践模式是否发生了变化。结果包括住院率，吞咽评估的频率，其他诊断测试，和反流诊断，护理费用，以及重复访问的次数。根据是否在指南实施之前或之后进行比较。
总共，359名受试者（186名，173个后指南)被确定。在指南实施之前或之后，实践模式或结果没有显着差异。受试者的平均年龄为2.53±0.15个月，80%住院2.49±0.26天。每个受试者进行了2.47次诊断测试，89%为非缴费型。尽管只有13%的人进行了荧光透视吞咽研究，72%表现为吸入/渗透。没有受试者进行胃食管反流测试，然而，在40%的受试者中，反流被认为是入院的原因，导致使用抑酸药物的出院几率增加（OR2.88，95%CI1.68-4.92，P=0.0001）。在后续行动中,28%的受试者因持续症状而重复住院或急诊就诊。
患有BRUE的婴儿继续接受低产量的诊断测试，入院后仍有症状并经常重新接受医疗护理。尽管燕子的产量很高，但燕子测试仍然很少见，反流继续受到牵连，尽管缺乏疗效，但仍有儿童因抑酸而出院。
我们对波士顿儿童医院在指南实施前后一年内评估的BRUE婴儿进行了回顾性队列研究，以确定实践模式是否发生了变化。结果包括住院率，吞咽评估的频率，其他诊断测试，和反流诊断，护理费用，以及重复访问的次数。根据是否在指南实施之前或之后进行比较。
总共，359名受试者（186名，173个后指南)被确定。在指南实施之前或之后，实践模式或结果没有显着差异。受试者的平均年龄为2.53±0.15个月，80%住院2.49±0.26天。每个受试者进行了2.47次诊断测试，89%为非缴费型。尽管只有13%的人进行了荧光透视吞咽研究，72%表现为吸入/渗透。没有受试者进行胃食管反流测试，然而，在40%的受试者中，反流被认为是入院的原因，导致使用抑酸药物的出院几率增加（OR2.88，95%CI1.68-4.92，P=0.0001）。在后续行动中,28%的受试者因持续症状而重复住院或急诊就诊。
患有BRUE的婴儿继续接受低产量的诊断测试，入院后仍有症状并经常重新接受医疗护理。尽管燕子的产量很高，但燕子测试仍然很少见，反流继续受到牵连，尽管缺乏疗效，但仍有儿童因抑酸而出院。
