Do all infants with apparent life-threatening events need to be admitted?
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 [corrected] 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%.
Claudius
Ilene
I
Division of Emergency and Transport Medicine, Keck School of Medicine, Childrens Hospital Los Angeles, 4650 Sunset Blvd, MS 113, Los Angeles, CA 90027, USA. iclaudius@chla.usc.edu
Keens
Thomas
T
D000367:Age Factors; D000402:Airway Obstruction / Q000175:diagnosis / Q000628:therapy; D001049:Apnea / Q000175:diagnosis / Q000628:therapy; D002140:California / Q000453:epidemiology; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D003490:Cyanosis / Q000175:diagnosis / Q000628:therapy; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006301:Health Services Needs and Demand; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000592:standards* / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000592:standards* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate