1. ASSESSMENT OF APPARENT LIFE-THREATENING EVENTS AT AN ACUTE CARE SETTING Javier Benito-Fernández 1 M.D., Mikel Santiago-Burruchaga 2 M.D., Jesus Sánchez- Etxaniz 2 M.D., Carlos Vazquez-Cordero 1 M.D., Santiago Mintegi-Raso 2 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. 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. n (%)Idiopathic (42) Secondary (24)OR(95% CI)p Age (weeks) 6,39  6,357,32  5,58 -----0,53 Pregnancy (weeks) 38,54  2,2137,04  3,74 -----0,05 Pregnancy < 37 weeks6 (14%)8 (34%)3 (0,89-10,07)0,06 Birth weight (grams) 3203,78  534,52795  773,03 -----0,019 Birth weight < 2500 grams5 (12%)6 (25%)2,47 (0,66-9,18)0,2 Admittance to Neonatal Unit 3 (7,3%)10 (38,4%)9,29 (2,23-38,7)0,001 Maternal breastfeeding26 (65%)9 (37,5%)0,37 (0,13-1,04)0,032 Previous ALTEs9 (21,9%)7 (26,9%)1,51 (0,48-4,76)0,64 Previous behavioural abnormalities 11 (26,8%)9 (34,6%)1,69 (0,58-4,96)0,49 URTI in days prior to episode 14 (34%)14 (56%)2,80 (1,00-7,88)0,08 Duration of episode103,46 ± 213116,85 ± 179-----0,8 Relationship to sleep15 (37,5%)5 (20%)0,47 (0,15-1,53)0,155 Major signs on examination 5 (12%)8 (32%)3,7 (1,05-13,07)0,05 Recurrence in PED2 (4,8%)6 (24%)6,6 (1,22-36,28) 0,021 Intervention in PED3 (7%)10 (40%)9,29 (2,23-38,7)0,01 Haemoglobin (gr/dl)13,43 ± 2,811,4 ± 2-----0,06 Lactate (mg/dl)34,39 ± 14,4441,72 ± 28,43-----0,1 pH7,36 ± 0,077,31 ± 0,13----- 0,05 Bicarbonate (mEq/L)25,53 ± 3,1723,75 ± 5,66-----0,1 Blood glucose (mg/dl)90,46 ± 23,17104,08 ± 46,56------ 0,11 Ammonia (mg/dl)59,03 ± 26,4190,45 ± 115------0,1 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 Secondary ALTEs 24 (36%) Abuse: 3% 45 21 Admitted to Observation Unit Admitted to Infant ward 7 to PICU Mean length of stay 11.3±5 h. 4 to infant ward 1.Lactate (>30mg/dl) 2.Platelets (>500 x103) 3.Ammonia (>80 mg/dl) 4.pH (<7.30) 5.Leucocytes ( 15 x103) 6.Bicarbonate(<20 mEq/L) 7.Chest x-ray 8.Blood glucose ( 140 mg/dl) 9.ALT (>50 IU) 10.Haemoglobin (<9 gr/dl) 11.ECG 12.Carboxyhaemoglobin 13.RSV test 14.Bordetella culture 15.Influenza Test 16.CRP (>2 mg/dl) Patological Performed LI abnormal LI normal Related diagnosis Laboratory Investigations (LI) Pneumonia (2) Bronchiolitis Pertussis Flu CMD CAH CO poisoning Sepsis 3531 9 14 52 Abnormalities at examination (21%) Normal examination Recurrences at the PED (12%) 8 Pertussi CAH GER Bronchiolitis Pneumonia BPD 11 LI abnormal 10 admitted 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 Risk factors clinical history and physical examination normal: 29 LI didn´t contribute to diagnose of any of the 5 Secondary EAL