Article type
Year
Abstract
Background: Apparent life threatening events (ALTEs), particularly in infants who appear well subsequently, present the clinician with a difficult diagnostic and management dilemma.
Objectives: To determine the diagnoses when infants first present with ALTEs. Data sources: We searched Medline (1966 - 2002) EMBASE (1980 - 2002) and CINAHL (1982- 2002). Primary authors and content experts were contacted to identify further studies. In addition, bibliographies from studies, reviews and textbooks were searched. Foreign language studies were translated.
Study selection: Articles were included if they met the following criteria: ALTE was clearly defined at presentation and the evaluation and investigations recorded were from the initial contact. Case reports and studies focusing on single conditions or non-clinical data were excluded. Results: From an initial 2912 papers, eight studies involving 643 infants (age range 0 - 13 months) were included. Agreement between reviewers was good (Kappa 0.71). All studies were non-randomised and methodological quality varied. Four studies were based in the emergency department. All diagnoses were made after evaluation in hospital but investigation protocols varied widely. There were 728 diagnoses assigned overall. The most common diagnoses reported were gastro-oesophageal reflux [n= 227, 31%], seizure [n=83, 11%], lower respiratory tract infection [n=58, 8%] and unknown [n=169, 23%]. Fifty different diagnoses were noted among all the studies. Some infants had more than one diagnosis. Follow up was comprehensive in two studies, limited in five and not reported in one. Five deaths were noted in total. Conclusions: Many different diagnoses are reported after evaluation of ALTEs but gastro-oesophageal, lower respiratory tract infection, seizure and unknown cause are the most common. Differing management protocols contributed to variations in the frequency of diagnosis. The development and validation of an evidence-based diagnostic plan may help with the care of this common condition.
Objectives: To determine the diagnoses when infants first present with ALTEs. Data sources: We searched Medline (1966 - 2002) EMBASE (1980 - 2002) and CINAHL (1982- 2002). Primary authors and content experts were contacted to identify further studies. In addition, bibliographies from studies, reviews and textbooks were searched. Foreign language studies were translated.
Study selection: Articles were included if they met the following criteria: ALTE was clearly defined at presentation and the evaluation and investigations recorded were from the initial contact. Case reports and studies focusing on single conditions or non-clinical data were excluded. Results: From an initial 2912 papers, eight studies involving 643 infants (age range 0 - 13 months) were included. Agreement between reviewers was good (Kappa 0.71). All studies were non-randomised and methodological quality varied. Four studies were based in the emergency department. All diagnoses were made after evaluation in hospital but investigation protocols varied widely. There were 728 diagnoses assigned overall. The most common diagnoses reported were gastro-oesophageal reflux [n= 227, 31%], seizure [n=83, 11%], lower respiratory tract infection [n=58, 8%] and unknown [n=169, 23%]. Fifty different diagnoses were noted among all the studies. Some infants had more than one diagnosis. Follow up was comprehensive in two studies, limited in five and not reported in one. Five deaths were noted in total. Conclusions: Many different diagnoses are reported after evaluation of ALTEs but gastro-oesophageal, lower respiratory tract infection, seizure and unknown cause are the most common. Differing management protocols contributed to variations in the frequency of diagnosis. The development and validation of an evidence-based diagnostic plan may help with the care of this common condition.