How to evaluate the child presenting with an apparent life-threatening event?
BACKGROUND
Infants who have experienced an apparent life-threatening event typically undergo an extensive evaluation to rule out serious underlying conditions.


OBJECTIVE
To evaluate the yield of different tests performed after an apparent life-threatening event and to identify high risk groups in which more extensive diagnostic tests are required.


METHODS
A retrospective study was conducted in a children's hospital for a 4 year period and the charts of infants who were admitted with an apparent life-threatening event were reviewed. The yield for each diagnostic test was established according to the ratio of positive results contributing to the diagnosis of the apparent life-threatening event.


RESULTS
The study included 69 infants between the ages of 1 week and 1 year. There were abnormal findings in 36% of the cases. Gastroesophageal reflux was the most common diagnosis (60%). In the remaining patients the diagnosis was either seizures (12%) or respiratory tract infections (28%). Tests used for the diagnosis of cardiac, metabolic and nonrespiratory infections had no yield. A positive correlation was found between abnormal test results and abnormal physical examination (P = 0.001), an abnormal perinatal history (P = 0.017), and age older than 2 months (P = 0.002).


CONCLUSIONS
The yield of most of the tests performed after an apparent life-threatening event is low, especially in infants with a normal perinatal history and physical examination.
Weiss
Karin
K
Department of Pediatrics, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Fattal-Valevski
Aviva
A
Reif
Shimon
S
D000367:Age Factors; D001049:Apnea / Q000175:diagnosis; D015331:Cohort Studies; D016638:Critical Illness; D003937:Diagnosis, Differential; D019937:Diagnostic Techniques and Procedures; D004200:Diseases in Twins; D004630:Emergencies; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis; D005764:Gastroesophageal Reflux / Q000175:diagnosis; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008487:Medical History Taking; D010808:Physical Examination; D011237:Predictive Value of Tests; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis