Monday, February 18, 2013

The Grim World of ALTE

"The risk of subsequent mortality in infants admitted from our pediatric ED with an ALTE is substantial."

Dire conclusions!  Doom and gloom associated with apparent life-threatening events!

This is a little bit of an odd article.  It's a chart review of all infants aged 0 to 6 months presenting with an ALTE – including seizure, choking spell, and cyanosis.  The authors reviewed 176 charts of admitted patients, follow-up studies, and eventual mortality.

  • 111 received blood cultures – all negative.
  • 65 received lumbar puncture – all negative.
  • 113 received chest x-rays – 12 of which had infiltrates.
  • 35 received non-contrast head CT – all negative.
  • 62 were tested for RSV - 9 were positive.

So, how many infants died after their ALTE to spawn this conclusion of "substantial" mortality?


This leads to the authors to conclude this high-risk complaint requires admission.  However, each death was a generally previously healthy patient was admitted with ALTE, evaluated extensively as an inpatient, discharged from the inpatient service – and died within two weeks, regardless.  The only reasoning I can fathom for this recommendation is as a cover-your-ass strategy to prevent being the physician who "last touched" the patient when someone comes back with a lawyer. 

"Mortality after discharge in clinically stable infants admitted with a first-time apparent life-threatening event"

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