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  • Title: How to evaluate the child presenting with an apparent life-threatening event?
    Author: Weiss K, Fattal-Valevski A, Reif S.
    Journal: Isr Med Assoc J; 2010 Mar; 12(3):154-7. PubMed ID: 20684179.
    Abstract:
    BACKGROUND: Infants who have experienced an apparent life-threatening event typically undergo an extensive evaluation to rule out serious underlying conditions. OBJECTIVES: To evaluate the yield of different tests performed after an apparent life-threatening event and to identify high risk groups in which more extensive diagnostic tests are required. METHODS: A retrospective study was conducted in a children's hospital for a 4 year period and the charts of infants who were admitted with an apparent life-threatening event were reviewed. The yield for each diagnostic test was established according to the ratio of positive results contributing to the diagnosis of the apparent life-threatening event. RESULTS: The study included 69 infants between the ages of 1 week and 1 year. There were abnormal findings in 36% of the cases. Gastroesophageal reflux was the most common diagnosis (60%). In the remaining patients the diagnosis was either seizures (12%) or respiratory tract infections (28%). Tests used for the diagnosis of cardiac, metabolic and nonrespiratory infections had no yield. A positive correlation was found between abnormal test results and abnormal physical examination (P = 0.001), an abnormal perinatal history (P = 0.017), and age older than 2 months (P = 0.002). CONCLUSIONS: The yield of most of the tests performed after an apparent life-threatening event is low, especially in infants with a normal perinatal history and physical examination.
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