This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (14)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Child Abuse  • Neonatology and Infant Care  • Violence and Human Rights  • Alert me on articles by topic  Social Bookmarking   What's this?

Robin L. Altman, MD; Donald A. Brand, PhD; Scott Forman, MD; Martin L. Kutscher, MD; Diana B. Lowenthal, MD; Kathleen A. Franke, MPH; Vanessa V. Mercado, MD

Arch Pediatr Adolesc Med. 2003;157:1011-1015.

Background  An apparent life-threatening event (ALTE) refers to the sudden occurrence of a breathing abnormality, color change, or alteration in muscle tone or mental status in an infant. Several patients with ALTEs admitted to our institution were found to have sustained abusive head injuries.

Objective  To systematically examine the possible causes of ALTEs and their relative frequencies.

Study Design  Prospective consecutive case series of 243 infants younger than 12 months admitted to a tertiary care academic medical center for evaluation of an ALTE during a 32-month interval.

Results  Thirty-five different causes of ALTEs were identified. Six subjects (2.5%) were diagnosed as having abusive head injuries, or 1 admission every 5 months. Three patients died in the hospital, 2 of whom were diagnosed as having abusive head injuries.

Conclusions  A wide spectrum of diseases and disorders can precipitate an ALTE. Among them, abusive head injury, a recently recognized cause, occurs frequently enough to obligate its inclusion in the differential diagnosis. An ophthalmologic evaluation with dilated fundus examination and cranial imaging should therefore be considered early in the investigation unless another cause becomes apparent soon after admission.

From the Departments of Pediatrics (Drs Altman, Brand, Kutscher, Lowenthal, and Mercado) and Ophthalmology (Dr Forman), Westchester Medical Center, and the Center for Primary Care Education and Research (Dr Brand and Ms Franke), New York Medical College, Valhalla.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Clues That Aid in the Diagnosis of Nonaccidental Trauma Presenting as an Apparent Life-Threatening Event
Vellody et al.
CLIN PEDIATR 2008;47:912-918.
ABSTRACT  

Death, Child Abuse, and Adverse Neurological Outcome of Infants After an Apparent Life-Threatening Event
Bonkowsky et al.
Pediatrics 2008;122:125-131.
ABSTRACT | FULL TEXT  

Infections and Apparent Life-Threatening Events
Altman et al.
CLIN PEDIATR 2008;47:372-378.
ABSTRACT  

Yield of Diagnostic Testing in Infants Who Have Had an Apparent Life-Threatening Event
Brand et al.
Pediatrics 2005;115:885-893.
ABSTRACT | FULL TEXT  

Apparent Life-Threatening Events as an Indicator of Occult Abuse
Maffei et al.
Arch Pediatr Adolesc Med 2004;158:402-402.
FULL TEXT  

Child Abuse and Apparent Life-Threatening Events
Paul and Spivack
AAP Grand Rounds 2004;11:3-4.
FULL TEXT