title: Management of apparent life-threatening events in infants: a systematic review.
abstract: OBJECTIVE
  To determine in patients who are well-appearing and without a clear etiology after an apparent life-threatening event (ALTE): (1) What historical and physical examination features suggest that a child is at risk for a future adverse event and/or serious underlying diagnosis and would, therefore, benefit from testing or hospitalization? and (2) What testing is indicated on presentation and during hospitalization?
  
  
  METHODS
  Systematic review of clinical studies, excluding case reports, published from 1970 through 2011 identified using key words for ALTE.
  
  
  RESULTS
  The final analysis was based on 37 studies; 18 prospective observational, 19 retrospective observational. None of the studies provided sufficient evidence to fully address the clinical questions. Risk factors identified from historical and physical examination features included a history of prematurity, multiple ALTEs, and suspected child maltreatment. Routine screening tests for gastroesophageal reflux, meningitis, bacteremia, and seizures are low yield in infants without historical risk factors or suggestive physical examination findings.
  
  
  CONCLUSIONS
  Some historical and physical examination features can be used to identify risk in infants who are well-appearing and without a clear etiology at presentation, and testing tailored to these risks may be of value. The true risk of a subsequent event or underlying disorder cannot be ascertained. A more precise definition of an ALTE is needed and further research is warranted.
authors: Department of Pediatrics, Division of Hospital Medicine, Seattle Children's Hospital and the University of Washington, Seattle, WA 98105, USA. joel.tieder@seattlechildrens.org
authors: Joel S
authors: JS
authors: Tieder
authors: Robin L
authors: RL
authors: Altman
authors: Joshua L
authors: JL
authors: Bonkowsky
authors: Donald A
authors: DA
authors: Brand
authors: Ilene
authors: I
authors: Claudius
authors: Diana J
authors: DJ
authors: Cunningham
authors: Craig
authors: C
authors: DeWolfe
authors: Jack M
authors: JM
authors: Percelay
authors: Raymond D
authors: RD
authors: Pitetti
authors: Michael B H
authors: MB
authors: Smith
mesh_terms: D057768:Brief, Resolved, Unexplained Event / Q000175:diagnosis*; D006801:Humans; D007223:Infant