From the Research
Adult failure to thrive (AFTT) in the emergency department requires a comprehensive approach focusing on immediate stabilization and identifying underlying causes, with a recent study suggesting that patients with an admission diagnosis of failure to thrive often have acute medical conditions on presentation 1. Begin with a thorough assessment including vital signs, mental status, and physical examination to identify acute medical issues requiring immediate intervention. Obtain laboratory studies including complete blood count, comprehensive metabolic panel, thyroid function tests, urinalysis, and inflammatory markers. Consider chest X-ray and ECG to rule out cardiopulmonary causes. Ensure adequate hydration with IV fluids if needed (typically normal saline at 1-2 L initially, then maintenance based on clinical status). Address nutritional deficiencies with appropriate supplementation and consider consultation with a dietitian. Pain management should be implemented if pain is contributing to functional decline. Medication reconciliation is essential to identify polypharmacy issues or adverse effects. Screen for depression using tools like the PHQ-9 and assess cognitive function with tools such as the Mini-Mental State Examination. Social work consultation should be initiated early to evaluate home situation, support systems, and need for additional services. Admission criteria include inability to maintain hydration/nutrition, acute medical conditions requiring inpatient management, significant functional decline, or unsafe discharge situation. AFTT represents a complex interplay of medical, psychological, and social factors requiring a multidisciplinary approach to effectively address the patient's needs and prevent further decline, as highlighted in a study that found patients with a diagnosis of failure to thrive had significant delays in care and often had acute medical conditions at discharge 1.
Some key points to consider in the management of AFTT include:
- The importance of early identification and treatment of underlying medical conditions, as patients with a diagnosis of failure to thrive may have acute medical conditions on presentation 1
- The need for a multidisciplinary approach, including consultation with a dietitian, social worker, and other specialists as needed
- The importance of addressing nutritional deficiencies and ensuring adequate hydration
- The need for careful medication reconciliation and management of polypharmacy issues
- The importance of screening for depression and assessing cognitive function
Overall, the management of AFTT in the emergency department requires a comprehensive and multidisciplinary approach, with a focus on identifying and treating underlying medical conditions, addressing nutritional deficiencies, and ensuring adequate hydration and medication management, as supported by recent studies 1.