Apparent life-threatening event admissions and gastroesophageal reflux disease: the value of hospitalization

Pediatr Emerg Care. 2012 Jan;28(1):17-21. doi: 10.1097/PEC.0b013e31823ed6f8.

Abstract

Background: No standard management plan for infants with an apparent life-threatening event (ALTE) currently exists. These infants are routinely hospitalized. Benefits of hospitalization of ALTE patients with gastroesophageal reflux disease (GERD) need definition.

Objectives: The study's objectives were to determine the accuracy of a working diagnosis of GERD in infants admitted with ALTE and to describe the history and hospital course of infants with both working and discharge diagnoses of GERD.

Methods: Authors retrospectively reviewed records from a large children's hospital of infants aged 1 year old and younger hospitalized from January 1, 2004, to March 1, 2007, with an admission diagnosis of ALTE. Demographics, clinical presentation, testing, hospital course, and 6-month postdischarge visits were abstracted. Intensive care admissions were excluded. Univariate and multivariate analyses identified factors associated with a discharge diagnosis of GERD.

Results: Three hundred thirteen infants met inclusion. Mean age was 2.1 months; mean length of stay was 2.5 days. A discharge diagnosis of GERD was most common (n = 154, 49%); 138 (89%) were initially well appearing, 10 (6%) had in-hospital events, and only 20 (13%) had upper gastrointestinal series performed. Concordance of initial working to discharge diagnosis of GERD was 96%. Nonconcordant diagnoses evolved within 24 hours. Rescue breaths and calling 911 were independently associated with a discharge diagnosis of GERD. Within 6 months, 14 patients (9%) with a discharge diagnosis of GERD had recurrent ALTE, and 5 (3%) had significant new diagnoses.

Conclusions: Concordance of initial working diagnosis with discharge diagnosis of GERD in ALTE patients is high. However, in hospital events, evolution to new diagnoses and recurrent ALTE suggest that hospitalization of these patients is beneficial. Diagnostic studies should not be routine but should target concerns from the history, examination, and hospital course.

MeSH terms

  • Airway Obstruction
  • Apnea / etiology*
  • California / epidemiology
  • Consciousness Disorders / etiology
  • Cyanosis / etiology*
  • Disease Management
  • Emergencies*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Gastroesophageal Reflux / complications
  • Gastroesophageal Reflux / diagnosis*
  • Gastroesophageal Reflux / epidemiology
  • Hospitalization / statistics & numerical data*
  • Hospitals, Pediatric / statistics & numerical data
  • Hospitals, Teaching / statistics & numerical data
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / diagnosis
  • Infant, Premature, Diseases / epidemiology
  • International Classification of Diseases
  • Male
  • Muscle Hypotonia / etiology*
  • Patient Admission / statistics & numerical data*
  • Patient Discharge / statistics & numerical data
  • Patient Readmission / statistics & numerical data
  • Recurrence
  • Retrospective Studies