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Apparent Life-Threatening Event (ALTE) ICD-9-CM Code Proposal精选
Apparent Life-Threatening Event (ALTE) ICD-9-CM Code Proposal Jack Percelay, MD, MPH, FAAP Jeffrey Linzer Sr., MD, FAAP Overview ALTE definition Epidemiology Variability in clinical approach Need for an evidence basis Limitations of proxy codes ALTE defined an episode that is frightening to the observer and is characterized by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic or pallid but occasionally erythematous or plethoric), marked change in muscle tone (usually marked limpness), choking, or gagging.” National Institutes of Health, Consensus Development Conference on Infantile Apnea and Home Monitoring, Sept 29 to Oct 1, 1986. Pediatrics.1987; 79 :292 –299. What are the causes of an ALTE? 33-50%: GI (gastroesophageal reflux) 15-30%: Neurologic (seizures) 11-20%: Respiratory (lower respiratory tract infections) 4%: ENT 1-5%: Cardiac In approximately 25-50% of cases no cause can be identified Kahn A. Eur J Pediatr (2004) 163: 108–115 McGovern MC, Smith MBH. Arch Dis Child (2004) 89:1043–1048 Apnea does not equal ALTE Apnea up to 20 seconds occurs in 43% of healthy term infant Ramanathan R. JAMA (2001) 285:2199-207 0.2-0.9% of infants have apnea requiring admission Mitchell EA. Acta Paediatr (2001) 90:417-22 Wennergren G. Acta Paediatr Suppl (1993) 82(Suppl 389):S114-6 Kiechl-Kohlendorfer, U. Arch Dis Child (2004) 90:297-300 Evaluation of ALTE Lack of consensus in approach reflux testing (pH probe study or upper GI) sleep study EEG ECG head CT chest x-ray lumbar puncture medications for presumed infection or GER Tieder JS. J Pediatr (2008) 152:629-35 Cost to US Healthcare System Tieder’s study of 12,067 patients admitted for ALTE showed Mean length of stay of 4.4 days (±5.6 days) Mean adjusted charges of $15,567 (±$28,510) per admission Mean in-hospital mortality rate was 0.56% 30-day readmission rate was 2.5% Actually, we’re not sure of the impact on the healthcare system Because there is no unique code for ALTE Tied
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