title: Apparent life threatening events in infants presenting to an emergency department.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Accident and Emergency Department, Royal London Hospital, London, UK. Ffion-Davies@bartsandthelondon.nhs.uk
authors.forename: F
authors.initials: F
authors.lastname: Davies
authors.forename: R
authors.initials: R
authors.lastname: Gupta
mesh_terms: D016638:Critical Illness; D004630:Emergencies; D004636:Emergency Service, Hospital; D004739:England; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies