F Davies1, R Gupta. 1. Accident and Emergency Department, Royal London Hospital, London, UK. Ffion-Davies@bartsandthelondon.nhs.uk
Abstract
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.
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.
Authors: Robin Grant; Therese Dowswell; Eve Tomlinson; Paul M Brennan; Fiona M Walter; Yoav Ben-Shlomo; David William Hunt; Helen Bulbeck; Ashleigh Kernohan; Tomos Robinson; Theresa A Lawrie Journal: Cochrane Database Syst Rev Date: 2020-09-04
Authors: Ben A Semmekrot; Bregje E van Sleuwen; Adele C Engelberts; Koen F M Joosten; Jaap C Mulder; K Djien Liem; Rob Rodrigues Pereira; Rob P G M Bijlmer; Monique P L'Hoir Journal: Eur J Pediatr Date: 2009-06-21 Impact factor: 3.183