title: Usefulness of airway evaluation in infants initially seen with an apparent life-threatening event.
abstract: OBJECTIVE
  To determine how often the pediatric otolaryngology service is involved in the initial care of infants with an apparent life-threatening event (ALTE), to assess the usefulness of bronchoscopy and laryngoscopy in diagnosing the underlying etiology, and to describe the long-term airway outcomes and whether these patients were seen by the pediatric otolaryngology service over a 5-year follow-up period.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Tertiary children's hospital affiliated with a university hospital.
  
  
  METHODS
  Screened were 187 903 patient visits for infants younger than 12 months. A total of 1148 infants with an ALTE were identified, 471 of whom met study inclusion criteria. To identify the study population, these infants were cross-referenced against a database of 5156 patients who underwent airway evaluation by the pediatric otolaryngology service.
  
  
  METHODS
  Airway evaluation with or without intervention.
  
  
  RESULTS
  Four hundred seventy-one infants with an ALTE met study inclusion criteria, 9 of whom subsequently underwent airway evaluation via bronchoscopy, laryngoscopy, or both. Three were referred during their initial ALTE admission, and 6 were seen later in childhood. Five of 9 patients had normal findings, 3 patients had laryngomalacia (including 2 with laryngeal edema), and 1 patient had adenotonsillar hypertrophy. Interventions consisted of 2 supraglottoplasties and 1 adenotonsillectomy.
  
  
  CONCLUSIONS
  Among well-appearing infants hospitalized with an ALTE, 98.1% (462 of 471) did not undergo subsequent airway evaluation, and only 0.6% (3 of 471) ultimately required pediatric otolaryngologic surgical intervention during 5 years after the event. This study shows that otolaryngologists are not frequently consulted for well-appearing infants with an ALTE and that airway abnormalities are rare.
authors.affiliation: Division of Otolaryngology–Head and Neck Surgery, Departments of Surgery), University of UtahSchool of Medicine, Salt LakeCity, USA.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Willis
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Bonkowsky
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.forename: J Fredrik
authors.initials: JF
authors.lastname: Grimmer
mesh_terms: D057768:Brief, Resolved, Unexplained Event / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D001999:Bronchoscopy / Q000706:statistics & numerical data; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000150:complications / Q000601:surgery; D007828:Laryngoscopy / Q000706:statistics & numerical data; D008297:Male; D010608:Pharyngeal Diseases / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014589:Utah