Related Experiment Video
Updated: May 31, 2026
Scanning Skeletal Remains for Bone Mineral Density in Forensic Contexts
Published on: January 29, 2018
Mortality and child abuse in children presenting with apparent life-threatening events
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA 15224, USA.
Insights
Apparent life-threatening events (ALTE) in children rarely result in death, but child abuse is an identifiable cause. Evaluating for child abuse is crucial in all ALTE cases due to its higher mortality risk.
Area of Science:
- Pediatrics
- Emergency Medicine
- Child Abuse and Neglect
Background:
- Children experiencing apparent life-threatening events (ALTE) often present well with normal examinations.
- Mortality following ALTE is infrequent but not well-characterized.
- Occult child abuse is associated with a high mortality rate in pediatric patients.
Purpose of the Study:
- To determine the mortality rate in children younger than 24 months presenting with an ALTE.
- To identify child abuse as a potential cause of mortality in ALTE cases.
Main Methods:
- Prospective enrollment of children under 24 months with ALTE.
- 12-month follow-up period to record mortality.
- Analysis of child abuse prevalence and associated mortality.
Main Results:
- 563 patients were enrolled over 9 years; mean age was 2.6 months.
- 11 patients (2%) were diagnosed with child abuse, more likely with focal findings (54% vs 17%).
- Overall mortality was 0.5% (3/563); one death was due to child abuse, two to SIDS. Child abuse victims had a 9% mortality rate.
Conclusions:
- While overall mortality for ALTE is low, child abuse is an identifiable cause of death.
- Child abuse should be considered in the evaluation of all children presenting with an ALTE.
Background:
Children who present to the emergency department following an apparent life-threatening event (ALTE) often appear well, have a normal physical examination, and usually do well. The incidence of mortality following an event appears to occur infrequently, but has not been well described. However, it has been our experience that children who are victims of occult child abuse have a high mortality rate.
Methods:
Children younger than 24 months who presented to the emergency department following an ALTE were prospectively enrolled and followed up for a period of 12 months. Mortality rate was recorded.
Results:
During the study period of 9 years, 563 patients were enrolled. The mean age of the patients was 2.6 months. Eleven patients (2%) were diagnosed with child abuse. Those diagnosed with child abuse were more likely to have focal findings on physical examination (54% vs 17%, P < 0.01). Three children died; the overall mortality rate was 0.5% (3/563). One of the 3 deaths was secondary to child abuse. The other 2 deaths were reported at autopsy to be secondary to sudden infant death syndrome. One of the 11 cases of child abuse ended in a death, which is a 9% mortality rate of child abuse victims who present with an ALTE.
Conclusions:
Although the subsequent mortality rate for children who present with an ALTE is low, child abuse was one of the identifiable causes of death and should be considered during evaluation of all children who present with an ALTE.
Related Concept Videos
01:22Life Tables
01:15Assumptions of Survival Analysis
01:23Acute Respiratory Failure-IV
01:28Anorexia Nervosa
Symptoms and Physical Effects
Individuals with anorexia nervosa commonly exhibit extreme...
01:30Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...
01:30Acute Respiratory Failure-III