ASSESSMENT OF APPARENT LIFE-THREATENING EVENTS AT AN ACUTE CARE SETTING

1. Abnormalities at examination (21%) Recurrences at the PED (12%) Secondary ALTEs 24 (36%) • GER 8 (12%) • Upper Respiratory tract infection (URTI) 4 (6%) • Pneumonia 2 (3%) • RSV bronchiolitis • Bordetella pertussis infection • Influenza • Bronchopulmonary dysplasia (BPD) • Congenital Adrenal Hyperplasia (CAH) • Congenital Metabolic Disease (CMD) • Sepsis • Carbon monoxide poisoning • Bordetella pertussis infection • Methadone poisoning • Subdural haematoma Normal examination Abuse: 3% Laboratory Investigations (LI) • Pneumonia (2) • Bronchiolitis • Pertussis • Flu • CMD • CAH • CO poisoning • Sepsis Mean length of stay 11.3±5 h. 4 to infant ward 7 to PICU 31 35 9 21 45 LI abnormal LI normal Related diagnosis Admitted to Observation Unit Admitted to Infant ward • Lactate (>30mg/dl) • Platelets (>500 x103) • Ammonia (>80 mg/dl) • pH (<7.30) • Leucocytes (<5 x103 or >15 x103) • Bicarbonate(<20 mEq/L) • Chest x-ray • Blood glucose (<50 or >140 mg/dl) • ALT (>50 IU) • Haemoglobin (<9 gr/dl) • ECG • Carboxyhaemoglobin • RSV test • Bordetella culture • Influenza Test • CRP (>2 mg/dl) Patological Performed Risk factors • Unexplained infant deaths in first degree family members • Perinatal risk factors • Previous ALTEs • Need for resuscitation manoeuvres • Abnormal examination and/or LIs • Need for any type of intervention in the PED • Recurrent episodes in the PED ASSESSMENT OF APPARENT LIFE-THREATENING EVENTS AT AN ACUTE CARE SETTING Javier Benito-Fernández1 M.D., Mikel Santiago-Burruchaga2 M.D., Jesus Sánchez-Etxaniz2 M.D., Carlos Vazquez-Cordero1 M.D., Santiago Mintegi-Raso2 M.D., 1- Paediatric Emergency Department; 2- Division of Paediatric Pulmonology. Goal:To report our experience with a systematic approach protocol for the assessment of Apparent Life-Threatening Events (ALTE) at our Paediatric Emergency Department (PED). Study design: Prospective, observational case series study of a systematic approach protocol for infants under age 12 months whose parents sought emergency care at our PED between 01/04/05 and 31/06/06 following an ALTE. • Pertussi • CAH • GER • Bronchiolitis • Pneumonia • BPD 8 14 52 10 admitted clinical history and physical examination normal: 29 LI didn´t contribute to diagnose of any of the 5 Secondary EAL 11 LI abnormal Conclusions: 1.The majority of the infants with a first episode of ALTE present in a generally good condition and have normal physical examination findings. 2.The absence of data suggesting underlying disease, following detailed history and examination, identify a pool of infants who may be handled conservatively. This group may be monitored as outpatients, after admitting them for a short period of observation. 3.The low yield of pathological tests make routine LIs would be possible to be avoided and its accomplishment would be reserved to the cases that presented an abnormal evolution during the period of observation. Fourth Mediterranean Emergency Medicine Congress (MEMC IV) in Sorrento, Italy, 15-19 September 2007.