We agree with the commentary of Dr Maffei and associates and support their suggestion to reconsider the definition of ALTE. Such a change in terminology would, in turn, be expected to increase awareness of the need to rule out inflicted injury in this group of patients.
While we agree with the concept of updating the definition of ALTE, it is not clear how best to redefine the term. The suggestion of Dr Maffei and associates is one possibility, but their definition leaves open to interpretation what would constitute "obvious examination findings." For example, would the term ALTE apply to a 5-week-old infant after a sudden episode of apnea if the physical examination revealed upper airway congestion? Although congestion could cause apnea, we would suggest that abusive head injury still be considered.
Altman RL, Brand DA. Apparent Life-Threatening Events as an Indicator of Occult Abuse—Reply. Arch Pediatr Adolesc Med. 2004;158(4):402. doi:10.1001/archpedi.158.4.402-b