Summary

ALTE occurs in up to 1% of infants. The emergency physician’s role in dealing with this entity is challenging, yet critical. While discharging a patient who may have experienced significant apnea is to be avoided, many of the patients who present to the emergency department with an ALTE likely did not experience apnea. Distinguishing those two populations is achieved mainly by taking a detailed history, followed by a thorough physical examination. At this point, most physicians should be able to disposition patients. Investigations that subsequently occur usually serve more to initiate an inpatient work-up for diagnosis and less as part of the decision-making analysis for the disposition of the patient.

References

1. Brand D.A., et al. Yield of diagnostic testing in infants who have had an apparent life-threatening event. Pediatrics 2005;115:885-93.
2. Torrey S.B. Apnea. In: Textbook of Pediatric Emergency Medicine, 5th ed. (Fleisher G.R., et al. (eds)). 2005. Lippincott Williams & Wilkins: Philadelphia, USA.
3. Waseem M., Dubbaka A. Apparent life-threatening event: Is there an increased risk for bacterial infections? Ann. Emerg. Med. 2008;52:S165.
4. Zuckerbraun N.S., et al. Occurrence of serious bacterial infection in infants aged 60 days or younger with an apparent life-threatening event. Pediatr. Emerg. Care. 2009;25:19-25.
5. Arad-Cohen N. et al. The relationship between gastroesophageal reflux and apnea in infants. J. Pediatrics 2000;137:321-36.
6. Puntis J.W., Booth I.W. ALTE and gastro-oesophageal reflux. Arch. Dis. Child. 2005;90:653.

Contributors

Dr. Tavor is in the pediatric emergency medicine academic fellowship program at the Hospital for Sick Children in Toronto. Dr. Mehta is a clinician-teacher in the division of pediatric emergency medicine at the Hospital for Sick Children in Toronto, and is an assistant professor of pediatrics at the University of Toronto. Medical Editor Dr. Robert C. Solomon is an attending emergency physician at Trinity Health System in Steubenville, Ohio, and clinical assistant professor of emergency medicine at the West Virginia School of Osteopathic Medicine.

Disclosures

In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards and American College of Emergency Physicians policy, contributors and editors must disclose to the program audience the existence of significant financial interests in or relationships with manufacturers of commercial products that might have a direct interest in the subject matter. Dr. Tavor, Dr. Mehta, and Dr. Solomon have disclosed that they have no significant relationships with or financial interests in any commercial companies that pertain to this educational activity. “Focus on: The ED Management of Pediatric Apparent Life Threatening Events” has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME). ACEP is accredited by the ACCME to provide continuing medical education for physicians. ACEP designates this educational activity for a maximum of one Category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those credits that he or she actually spent in the educational activity. “Focus on: The ED Management of Pediatric Apparent Life Threatening Events” is approved by ACEP for one ACEP Category 1 credit.