“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?
Two.
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”