title: Independent risk factors for recurrence of apparent life-threatening events in infants.
abstract: The risk factors for recurrent apparent life-threatening event (ALTE) are unclear although the risk of recurrent ALTE is an important consideration for the management of ALTE patients. This study aimed to identify the risk factors for recurrent ALTE. We conducted a secondary analysis of the data from a single center retrospective cohort study in Japan conducted from March 2002 to January 2012, which included children diagnosed with ALTE at a pediatric emergency department (ED) in Tokyo. Among 112 ALTE patients, 18 (16%) had recurrences and 94 (84%) did not. Symptoms of respiratory tract infection (RTI) were more frequent in the recurrent group than in the non-recurrent group (44 vs. 14% p = 0.0055), and the proportion of patients triaged as level 1 was larger in the recurrent group than in the non-recurrent group (31 vs. 7%, p = 0.0312). Pallor was observed more frequently in the recurrent group than in the non-recurrent group (100 vs. 76%, p = 0.0216). Multivariate analysis demonstrated that the independent risk factors of recurrent ALTE were respiratory tract infection symptoms (OR, 5.02; 95% CI, 1.48-16.98).
  
  
  CONCLUSIONS
  ALTE patients who had RTI symptoms at the ED visit for first ALTE should be admitted for close observation of potential recurrences. What is Known: • Approximately 10% of ALTE patients experienced recurrence of ALTE episodes. • The risk of recurrent ALTE is one of the major consideration for the management of ALTE patients at the ED because these patients have higher rates of serious underlying diseases which require interventions. What is New: • Respiratory infection symptoms at ED presentation can be independent risk factors for recurrent ALTE.
authors.affiliation: Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Riyo
authors.initials: R
authors.lastname: Ueda
authors.affiliation: Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan. osamunomura@hotmail.com.
authors.forename: Osamu
authors.initials: O
authors.lastname: Nomura
authors.affiliation: Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Maekawa
authors.affiliation: Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Sakai
authors.affiliation: Department of Critical Care and Anesthesia, National Center for Child Health and Development, Tokyo, Japan.|Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.|Department of Postgraduate Education and Training, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ishiguro
mesh_terms: D002675:Child, Preschool; D004630:Emergencies / Q000453:epidemiology*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014041:Tokyo / Q000453:epidemiology
keywords: Infantile apparent life-threatening event; Recurrence; Risk factors