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Pediatr Emerg Care. 2014 Apr;30(4):236-9. doi: 10.1097/PEC.0000000000000103.

Prevalence of electrocardiogram use in infants with apparent life-threatening events: a multicenter database study.

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From the Divisions of *General Pediatrics and †Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA.



An apparent life-threatening event (ALTE) is a common diagnosis in pediatrics, but there is no standardized method to evaluate these patients. We sought to determine the prevalence of electrocardiogram (ECG) use in patients presenting to children's hospitals with an ALTE.


The data from the Pediatric Health Information System database from 43 children's hospitals were collected during a 15-month period between October 2009 and December 2010. Patients were included if they were younger than 1 year at the time of presentation. Demographic data, including age, length of hospital stay, second ALTE, and survival, were recorded, along with the prevalence of ECGs and International Classification of Diseases, Ninth Revision, cardiac diagnoses.


There were 2179 patients with an ALTE, with a mean age of 65.7 days old and length of stay of 3.4 days. A total of 947 (43%) of these patients received an ECG. The prevalence of ECG use and cardiac diagnoses were variable among the participating hospitals. Depending on the institution, 0% to 93% of patients had an ECG, and 4% to 39% of patients had an International Classification of Diseases, Ninth Revision, cardiac diagnosis.


Electrocardiograms are performed in fewer than half of patients with ALTE presenting to children's hospitals. There is wide variation in the prevalence of ECG use as a diagnostic tool for infants presenting with an ALTE.

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