Published online April 2, 2007
PEDIATRICS Vol. 119 No. 4 April 2007, pp. 679-683 (doi:10.1542/peds.2006-2549)
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ARTICLE

Do All Infants With Apparent Life-Threatening Events Need to Be Admitted?

Ilene Claudius, MDa and Thomas Keens, MDb

a Divisions of Emergency and Transport Medicine
b Pulmonary Medicine, Keck School of Medicine, Childrens Hospital Los Angeles, Los Angeles, California

OBJECTIVE. The goal was to identify criteria that would allow low-risk infants presenting with an apparent life-threatening event to be discharged safely from the emergency department.

METHODS. We completed data forms prospectively on all previously healthy patients <12 months of age presenting to the emergency department of an urban tertiary care children's hospital with an apparent life-threatening event over a 3-year period. These patients were then observed for subsequent events, significant interventions, or final diagnoses that would have mandated their admission (eg, sepsis).

RESULTS. In our population of 59 infants, all 8 children who met the aforementioned outcome measures, thus requiring admission, either had experienced multiple apparent life-threatening events before presentation or were in their first month of life. In our study group, the high-risk criteria of age of <1 month and multiple apparent life-threatening events yielded a negative predictive value of 100% to identify the need for hospital admission.

CONCLUSIONS. Our study suggests that >30-day-old infants who have experienced a single apparent life-threatening event may be discharged safely from the hospital, which would decrease admissions by 38%.

Key Words: apnea • apparent life-threatening event • emergency department

Abbreviations: ALTE—apparent life-threatening event • ED—emergency department • SIDS—sudden infant death syndrome • HR—hospitalization required • HNR—hospitalization not required • OR—odds ratio • CI—confidence interval

Accepted Dec 12, 2006.


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