ALTE BRUE

10 causes of Apparent Life Threatening Emergencies (ALTE)

• ALTE = “a description of a clinical presentation”
• not clearly defined
  • very challenging for ER docs because the events range from minor to life threatening
  • up to 50% of cases have no definitive diagnosis

10 Causes of ALTE

1. infection
2. GERD
3. congenital pulmonary or vascular malformations
4. seizure disorders
5. cardiac dysrhythmias
6. metabolic issues (i.e. hypoglycemia)
7. head injury / non-accidental trauma
8. apnea NYD
9. breath holding
10. reactive airways

Etiology (more detailed):

• Infection
  • sepsis
  • RSV / other resp. viruses – 9%
  • febrile convulsion – 12%
  • pertussis – 6%
  • UTI
• GERD – 18%
  • with or without obstructive apnea
• congenital malformations
  • tracheomalacia, vascular rings, pulmonary slings
• seizure disorder – 25%
• cardiac dysrhythmias
• congenital cardiac malformations – 2%
• metabolic
  • hypoglycemia
• child abuse/ non-accidental trauma (NAT)
  • NAT don’t ever forget!!!!
• apnea – 9%
• asthma / head injury / feeding difficulties / breath holding

• ALTE child may look totally normal at the time of ED presentation (50% of the time) but any non-hospital person who witnessed choking or cyanosis should be taken seriously
• ED evaluation depends on hx and physical exam
• investigations +/-:
  • CBC, glucose, lytes, urine/blood cultures
  • tox screen, ECG
  • +-CT, CXR,
• children < 60 days should undergo thorough screening for infection with//without pediatrics assessment
  • EMRAP Claudius and Keens suggests kids <1 admitted="" be="" li="" month="">
• outcome:
  • variable depending on etiology
  • one retrospective review of 196 pts. showed no deaths: mostly asthma, GERD, and seizures
  • most well appearing infants can be discharged with close follow-up
• safe discharge criteria: according to Fu and Moon
  • brief, non-severe, and resolving episode
  • non progressive cause – GERD
  • no comorbidities
  • no previous ALTEs in 24 hrs