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Word of the Day

Infants with ALTEs rarely have serious bacterial infection

Clinical Question:
How often do infants with apparent life-threatening events have serious bacterial infections?

Bottom Line:
The inconsistent testing rates notwithstanding, the rate of serious infections in infants with apparent life-threatening events (ALTEs) is low. The authors' titular question is unanswerable given their design. However, given the low rate of bacterial infections, the next logical step would be to perform a study with uniform diagnostic evaluations and develop prediction rules to help identify infants at a higher probability of infection. (LOE = 2b)

Reference:
Claudius I, Mittal MK, Murray R, Condie T, Santillanes G. Should infants presenting with an apparent life-threatening event undergo evaluation for serious bacterial infections and respiratory pathogens? J Pediatr 2014;164(5):1231-1233.  [PMID:24484770]

Study Design:
Cohort (prospective)

Funding:
Unknown/not stated

Setting:
Emergency department

Synopsis:
Emergency department physicians evaluating 533 infants 12 months or younger with ALTEs recorded their clinical findings on a standardized data sheet. The physicians, however, ordered tests at their discretion. The researchers also followed the infants until hospital discharge (if admitted) or for 1 week if discharged from the emergency department. Just more than 10% of the time, physicians performed lumbar punctures, none of which revealed meningitis. Approximately one third of the infants had blood cultures obtained, with 16 showing contaminants and only 1 true positive. Similarly, approximately one third of the infants had urine cultures obtained: 8% were contaminated, 2% were true positives, and 1% possibly positive. Slightly more than half the infants had chest x-rays, 7% of which indicated bacterial pneumonia. Finally, approximately one third of the infants were tested for respiratory syncytial virus, about 10% of whom had a positive result. The authors don't say anything about the results of testing based on whether the infants looked ill. Remember, the physicians evaluating the patients tested in a discretionary manner. Since the authors don't describe anything about the experience level of the evaluating physician, we can only speculate that the rates reported are not the true rates of infection.

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