Riyo Ueda1, Osamu Nomura2, Takanobu Maekawa1, Hirokazu Sakai1, Satoshi Nakagawa3,4, Akira Ishiguro1,4. 1. Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan. 2. Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan. osamunomura@hotmail.com. 3. Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan. 4. Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.
Abstract
The risk factors for recurrent apparent life-threatening event (ALTE) are unclear although the risk of recurrent ALTE is an important consideration for the management of ALTE patients. This study aimed to identify the risk factors for recurrent ALTE. We conducted a secondary analysis of the data from a single center retrospective cohort study in Japan conducted from March 2002 to January 2012, which included children diagnosed with ALTE at a pediatric emergency department (ED) in Tokyo. Among 112 ALTE patients, 18 (16%) had recurrences and 94 (84%) did not. Symptoms of respiratory tract infection (RTI) were more frequent in the recurrent group than in the non-recurrent group (44 vs. 14% p = 0.0055), and the proportion of patients triaged as level 1 was larger in the recurrent group than in the non-recurrent group (31 vs. 7%, p = 0.0312). Pallor was observed more frequently in the recurrent group than in the non-recurrent group (100 vs. 76%, p = 0.0216). Multivariate analysis demonstrated that the independent risk factors of recurrent ALTE were respiratory tract infection symptoms (OR, 5.02; 95% CI, 1.48-16.98). CONCLUSION: ALTE patients who had RTI symptoms at the ED visit for first ALTE should be admitted for close observation of potential recurrences. What is Known: • Approximately 10% of ALTE patients experienced recurrence of ALTE episodes. • The risk of recurrent ALTE is one of the major consideration for the management of ALTE patients at the ED because these patients have higher rates of serious underlying diseases which require interventions. What is New: • Respiratory infection symptoms at ED presentation can be independent risk factors for recurrent ALTE.
The risk factors for recurrent apparent life-threatening event (ALTE) are unclear although the risk of recurrent ALTE is an important consideration for the management of ALTE patients. This study aimed to identify the risk factors for recurrent ALTE. We conducted a secondary analysis of the data from a single center retrospective cohort study in Japan conducted from March 2002 to January 2012, which included children diagnosed with ALTE at a pediatric emergency department (ED) in Tokyo. Among 112 ALTE patients, 18 (16%) had recurrences and 94 (84%) did not. Symptoms of respiratory tract infection (RTI) were more frequent in the recurrent group than in the non-recurrent group (44 vs. 14% p = 0.0055), and the proportion of patients triaged as level 1 was larger in the recurrent group than in the non-recurrent group (31 vs. 7%, p = 0.0312). Pallor was observed more frequently in the recurrent group than in the non-recurrent group (100 vs. 76%, p = 0.0216). Multivariate analysis demonstrated that the independent risk factors of recurrent ALTE were respiratory tract infection symptoms (OR, 5.02; 95% CI, 1.48-16.98). CONCLUSION: ALTE patients who had RTI symptoms at the ED visit for first ALTE should be admitted for close observation of potential recurrences. What is Known: • Approximately 10% of ALTE patients experienced recurrence of ALTE episodes. • The risk of recurrent ALTE is one of the major consideration for the management of ALTE patients at the ED because these patients have higher rates of serious underlying diseases which require interventions. What is New: • Respiratory infection symptoms at ED presentation can be independent risk factors for recurrent ALTE.
Authors: Joel S Tieder; Joshua L Bonkowsky; Ruth A Etzel; Wayne H Franklin; David A Gremse; Bruce Herman; Eliot S Katz; Leonard R Krilov; J Lawrence Merritt; Chuck Norlin; Jack Percelay; Robert E Sapién; Richard N Shiffman; Michael B H Smith Journal: Pediatrics Date: 2016-04-25 Impact factor: 7.124
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