Mortality and child abuse in children presenting with apparent life-threatening events.

BACKGROUND: Children who present to the emergency department following an apparent life-threatening event (ALTE) often appear well, have a normal physical examination, and usually do well. The incidence of mortality following an event appears to occur infrequently, but has not been well described. However, it has been our experience that children who are victims of occult child abuse have a high mortality rate.

METHODS: Children younger than 24 months who presented to the emergency department following an ALTE were prospectively enrolled and followed up for a period of 12 months. Mortality rate was recorded.

RESULTS: During the study period of 9 years, 563 patients were enrolled. The mean age of the patients was 2.6 months. Eleven patients (2%) were diagnosed with child abuse. Those diagnosed with child abuse were more likely to have focal findings on physical examination (54% vs 17%, P < 0.01). Three children died; the overall mortality rate was 0.5% (3/563). One of the 3 deaths was secondary to child abuse. The other 2 deaths were reported at autopsy to be secondary to sudden infant death syndrome. One of the 11 cases of child abuse ended in a death, which is a 9% mortality rate of child abuse victims who present with an ALTE.

CONCLUSIONS: Although the subsequent mortality rate for children who present with an ALTE is low, child abuse was one of the identifiable causes of death and should be considered during evaluation of all children who present with an ALTE.