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Apparent life threatening events in infants presenting to an emergency department
  1. F Davies,
  2. R Gupta
  1. Accident and Emergency Department, Royal London Hospital, London, UK
  1. Correspondence to:
 Dr F Davies, Accident and Emergency Department, Royal London Hospital, Whitechapel, London E1 1BB, UK;


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.

  • apparent life threatening event
  • sudden infant death syndrome
  • apnoea
  • (ALTE), apparent life threatening event
  • ED, emergency department
  • SIDS, sudden infant death syndrome
  • GOR, gastro-oesophageal reflus
  • LRTI, lower respiratory tract infection

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  • Funding: none.

  • Conflicts of interest: none.