How extensive should an ALTE workup be in the ED?

31 Aug
ALTE = Acute Life-Threatening Event

•Workup is very dependent on history and physical

If event did not seem to be life-threatening (eg, transient laryngospasm after an episode of reflux), then a full history and physical may be sufficient

•If event seems truly life-threatening with no alternative explanation,
  • check CBC, BMP, UA and culture, CXR, and EKG.
  • Consider a tox screen, blood cultures, or CSF studies in certain patients

Admit just about every ALTE, even if they look perfect in the ED. They may have a witnessed event in house, or another symptom or sign that provokes further evaluation (EEG, head CT, Holter, echo, metabolic studies)

Risk factors for clinically significant recurrences of apneic episodes on infants with idiopathic ALTE’s include:
  • History of prematurity
  • Postconceptional age under 43 weeks
  • History of multiple ALTEs preceding presentation to the hospital
  • Viral URI

Submitted by M. Smith.

References: Corwin MJ. Apparent life-threatening event in infants. www.uptodate.com, 2011.; picture
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