A survey of Healthcare Practitioners managing neonates who present to the emergency department with an apparent life threatening event - is awareness good enough?
Aims
Apparent life threatening events (ALTE) describe a non-specific group of symptoms, frightening to the on-looker, comprising a combination of apnoea, colour change, marked change in muscle tone and coughing or gagging. Occuring in children under 2, ALTE are concerning for both caregivers and professionals due to the event itself and the possibility of a serious underlying cause. It is essential to correctly identify an ALTE event at first contact in order to evaluate and manage appropriately. This study aimed to examine the level of awareness of ALTE among medical practitioners on the front-line.
Methods
A survey available both online and on paper was undertaken in a UK district general hospital with 6000 live-born infants per year. The emergency department (ED) is a mixed adult and paediatric environment. It was available for a 4-week period to all paediatric department and ED doctors and nurse practitioners likely to be involved in early assessment and management of these patients. Respondents were screened initially to determine who had an awareness or knowledge of an ALTE presentation in children; these then answered further questions about investigating and managing a neonate (up to 28 days old) presenting with ALTE who appeared well on examination using a typical scenario.
Results
33/83 practitioners responded to the survey (40% response rate). 30 participants returned usable questionnaires, but not all had all every single question answered - denominators reflect this. 17 (57%) were from paediatrics and 13 (43%) from ED.
21/30 (70%) were aware of ALTE as a presentation and therefore completed the full survey. Awareness was significantly higher in those working in paediatrics compared to ED (15 (88%) vs 6 (46%), p 0.02) There was a weakly positive correlation between time from graduation and increased awareness in those who provided this information (N = 26, R = 0.22, p 0.27).
Evaluation of knowledge showed 18/21 (86%) correctly identified risk factors for increased concern requiring closer assessment and investigation. There was inconsistent recognition of ALTE symptoms/signs (as per ICD-10 criteria) with no respondent recognizing all features (range of correct recognition (13-20/21 (62%-95%). However, up to 11/21 respondents (52%) incorrectly attributed other common symptoms to an ALTE presentation.
Discussion
This is a small local survey. However the participants are representative of those likely to be involved in the early management of infants with suspected ALTE. Awareness was significantly higher in those working in paediatrics compared to ED
Conclusion
There may need to be improved education and supervision, especially of junior doctors in ED, when assessing young and vulnerable infants. A larger, multicentre study will help clarify just what is known, and how education might be better delivered.
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