Caregivers' Perceptions and Hospital Experience After a Brief Resolved Unexplained Event: A Qualitative Study

Hosp Pediatr. 2019 Jul;9(7):508-515. doi: 10.1542/hpeds.2018-0220.


Background and objectives: The American Academy of Pediatrics published guidelines for evaluation and management of lower-risk infants for a brief resolved unexplained event (BRUE). The guideline identified gaps in knowledge related to caregiver satisfaction, anxiety, and family-centered educational strategies to improve caregiver experience and patient outcomes. The objective of this study was to understand caregivers' experience with hospitalization for infants with BRUE, including their perception of the hospital stay, the diagnosis of BRUE, and their feelings toward the upcoming discharge from the hospital.

Methods: We conducted a qualitative study using semistructured interviews with caregivers of infants aged 0 to 12 months who were admitted to a quaternary care children's hospital for a BRUE. Interviews were conducted within 24 hours of discharge. Two investigators coded transcripts and identified themes using consensus.

Results: Eighteen caregivers of 13 infants were interviewed. No infants met criteria for being low risk according to the American Academy of Pediatrics guidelines. The coding scheme produced 3 major themes. First, parents felt reassured by hospital monitoring, diagnostic evaluation, and staff support in the hospital. Second, parents felt unsettled by the uncertainty of the child's condition and whether BRUE's "unexplainable" quality is understood as being part of normal infant behavior. Third, these themes manifested as conflicting emotions about caregivers' readiness for discharge.

Conclusions: Although hospital monitoring may provide reassurance for some caregivers, they continue to struggle with the uncertainty of the diagnosis. Caregiver perspectives can inform physicians' strategies to improve hospital experience and discharge readiness.

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Caregivers / psychology*
  • Caregivers / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Practice Guidelines as Topic
  • Qualitative Research
  • Risk Factors
  • Sudden Infant Death / diagnosis
  • Sudden Infant Death / prevention & control*