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Apparent life threatening events in infants presenting to an emergency department
1Accident and Emergency Department, Royal London Hospital, London, UK. Ffion-Davies@bartsandthelondon.nhs.uk
Insights
Apparent life-threatening events (ALTE) in infants can have various causes, from reflux to serious conditions. Understanding risk factors helps in targeted emergency department evaluation and management.
Area of Science:
- Pediatrics
- Emergency Medicine
- Neonatology
Background:
- Apparent life-threatening events (ALTE) are common presentations in emergency departments.
- Identifying the etiology and prognosis of ALTE is crucial for infant care.
Purpose of the Study:
- To investigate the causes and outcomes of ALTE in infants presenting to an emergency department.
- To evaluate the effectiveness of an initial diagnostic protocol for ALTE.
Main Methods:
- A prospective study involving 65 infants under one year old presenting with ALTE.
- Standardized history taking and an initial investigation protocol were implemented.
- Infants were admitted and followed up for six months.
Main Results:
- Gastro-oesophageal reflux was the most common diagnosis (26%), followed by pertussis and seizures (9% each).
- No diagnosis was determined in 23% of cases.
- Serious diagnoses were linked to older age at presentation, abnormal clinical exams, and recurrent events.
Conclusions:
- ALTEs can be isolated unexplained events or stem from diverse causes, varying in severity.
- Recognizing common causes and high-risk indicators can refine emergency department diagnostic approaches.
- A targeted strategy improves decision-making, benefiting infants and their families.
Objective:
To describe the aetiology and outcome of apparent life threatening events (ALTE) presenting to an emergency department (ED), and to assess the value of an initial investigation protocol.
Design:
A 12 month prospective study of infants under 1 year of age who presented to a children's hospital ED after an ALTE. A standardised history sheet and initial investigation protocol were used. All infants were admitted to hospital and followed up at six months.
Results:
There were 65 infants recruited, median age 7 weeks. None had died at the time of writing. Diagnoses included gastro-oesophageal reflux n=17 (26%), pertussis, n=6 (9%), seizures, n=6 (9%), urinary tract infection (5), factitious illness (2), brain tumour, atrial tachycardia, persistent ductus arteriosus and opioid related apnoea. No diagnosis was reached in 15 cases (23%). Fifty seven (88%) had only one admission to hospital for ALTE. More serious diagnoses were associated with a presentation age over 2 months, abnormal initial clinical examination, and recurrent ALTE.
Conclusions:
ALTEs presenting to the ED may remain as a single, unexplained event or be attributable to numerous causes, ranging from minor to serious. Knowledge of the commoner causes and factors associated with higher risk could result in a more targeted approach, improving the decision making process and benefiting both infants and parents.