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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.

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