Management of an apparent life-threatening event: a survey of emergency physicians practice

The etiology of an apparent life-threatening event (ALTE) has been attributed to a wide range of causes. Physicians rely on caregiver narratives, which are often unreliable given the distressing nature of the event, which in turn leads to variation in the evaluation and management. The objective of this study was to study this variation in the management of ALTE among emergency physicians in Michigan.

The authors developed and conducted a survey that contained questions on the evaluation and management of 2 common ALTE scenarios. These surveys were then mailed to 1000 randomly selected emergency physicians from a comprehensive physician database.

A total of 25.5% responded. Majority of the respondents were trained in emergency medicine residency. Fourth-seven percent of the respondents work in suburban areas. Most respondents said that they would perform diagnostic laboratory workup on children presenting with ALTE although there is wide variation in the extent of the workup. Ninety-two percent of ALTE patients are likely to get pediatric subspecialist consultation from the emergency department.

There is a wide variation in the evaluation and management of ALTE among emergency medicine physicians in Michigan. These children with ALTE are very likely to be seen by pediatric subspecialists subsequently.