Abstract：
OBJECTIVE: In May 2016, the American Academy of Pediatrics published a clinical practice guideline (CPG) defining apparent life-threatening events (ALTEs) as brief resolved unexplained events (BRUEs) and recommending risk-based management. We analyzed the association of CPG publication on admission rate, diagnostic testing, treatment, cost, length of stay (LOS), and revisits in patients with BRUE.
METHODS: Using the Pediatric Health Information Systems database, we studied patients discharged from the hospital with a diagnosis of ALTE/BRUE from January 2012 to December 2019. We grouped encounters into 2 time cohorts on the basis of discharge date: preguideline (January 2012-January 2016) and postguideline (July 2016-December 2019). We used interrupted time series to test if the CPG publication was associated with level change and change in slope for each metric.
RESULTS: The study included 27 941 hospitalizations for ALTE/BRUE from 36 hospitals. There was an early decrease in 12 diagnostic tests that the CPG strongly recommended against. There was a positive change in the use of electrocardiogram (+3.5%, P < .001), which is recommended by CPG. There was a significant reduction in admissions (-13.7%, P < .001), utilization of medications (-8.3%, P < .001), cost (-$1146.8, P < .001), and LOS (-0.2 days, P < .001), without a change in the revisit rates. In the postguideline period, there were an estimated 2678 admissions avoided out of 12 508 encounters.
CONCLUSIONS: Publication of the American Academy of Pediatrics BRUE CPG was associated with substantial reductions in testing, utilization of medications, admission rates, cost, and LOS, without a change in the revisit rates.
METHODS: Using the Pediatric Health Information Systems database, we studied patients discharged from the hospital with a diagnosis of ALTE/BRUE from January 2012 to December 2019. We grouped encounters into 2 time cohorts on the basis of discharge date: preguideline (January 2012-January 2016) and postguideline (July 2016-December 2019). We used interrupted time series to test if the CPG publication was associated with level change and change in slope for each metric.
RESULTS: The study included 27 941 hospitalizations for ALTE/BRUE from 36 hospitals. There was an early decrease in 12 diagnostic tests that the CPG strongly recommended against. There was a positive change in the use of electrocardiogram (+3.5%, P < .001), which is recommended by CPG. There was a significant reduction in admissions (-13.7%, P < .001), utilization of medications (-8.3%, P < .001), cost (-$1146.8, P < .001), and LOS (-0.2 days, P < .001), without a change in the revisit rates. In the postguideline period, there were an estimated 2678 admissions avoided out of 12 508 encounters.
CONCLUSIONS: Publication of the American Academy of Pediatrics BRUE CPG was associated with substantial reductions in testing, utilization of medications, admission rates, cost, and LOS, without a change in the revisit rates.
摘要：
目的：2016年5月，美国儿科学会发布了一项临床实践指南（CPG），将明显危及生命的事件（ALTE）定义为短暂解决的无法解释的事件（BRUE），并建议基于风险的管理。我们分析了CPG出版物与录取率的关系，诊断测试,治疗,成本,停留时间(LOS)以及BRUE患者的重诊。
方法：使用儿科健康信息系统数据库，我们研究了2012年1月至2019年12月诊断为ALTE/BRUE的出院患者.我们根据出院日期将遇到的问题分为2个时间队列：指南前（2012年1月至2016年1月）和指南后（2016年7月至2019年12月）。我们使用中断的时间序列来测试CPG出版物是否与每个指标的水平变化和斜率变化相关。
结果：该研究包括36家医院的27941例ALTE/BRUE住院治疗。CPG强烈建议反对的12项诊断测试早期减少。心电图的使用有积极变化(+3.5%,P<.001),这是CPG推荐的。入学人数显着减少（-13.7%，P<.001),药物利用率（-8.3%，P<.001),成本（-1146.8美元，P<.001），和LOS(-0.2天，P<.001),没有改变重访率。在引导后期间，在12508次相遇中，估计有2678人避免入院。
结论：美国儿科学会的出版物BRUECPG与检测的大幅减少有关，利用药物，录取率，成本,还有LOS,没有改变重访率。
方法：使用儿科健康信息系统数据库，我们研究了2012年1月至2019年12月诊断为ALTE/BRUE的出院患者.我们根据出院日期将遇到的问题分为2个时间队列：指南前（2012年1月至2016年1月）和指南后（2016年7月至2019年12月）。我们使用中断的时间序列来测试CPG出版物是否与每个指标的水平变化和斜率变化相关。
结果：该研究包括36家医院的27941例ALTE/BRUE住院治疗。CPG强烈建议反对的12项诊断测试早期减少。心电图的使用有积极变化(+3.5%,P<.001),这是CPG推荐的。入学人数显着减少（-13.7%，P<.001),药物利用率（-8.3%，P<.001),成本（-1146.8美元，P<.001），和LOS(-0.2天，P<.001),没有改变重访率。在引导后期间，在12508次相遇中，估计有2678人避免入院。
结论：美国儿科学会的出版物BRUECPG与检测的大幅减少有关，利用药物，录取率，成本,还有LOS,没有改变重访率。
