Location: Children's Nutrition Research CenterTitle: The role of laboratory and imaging studies in evaluation of failure to thrive) Author
Submitted to: Pediatric Academic Society
Publication Type: Abstract Only
Publication Acceptance Date: 1/1/2010
Publication Date: N/A
Citation: Interpretive Summary:
Technical Abstract: Evaluation of Failure to Thrive (FTT) has traditionally been based on history and physical examination (PE), as main determinants of the final diagnosis. Early literature from two decades ago, demonstrated that laboratory and imaging studies were contributory beyond the history and PE in less than 1% of inpatient cases and were rarely indicated. Our objective was to examine the current inpatient FTT evaluation practice in order to assess the role of laboratory tests and imaging studies in establishing the cause of FTT today. Additionally, we assessed the relative prevalence of Organic vs. Non-organic vs. Mixed FTT among our inpatient FTT cases. We also looked at subgroup of our patients, children under 6 months of age who may have higher percentage of cognitive complications of FTT, and tried to examine if there is a difference in the work-up that this group got comparing to older patients. We conducted a retrospective charts review of consecutive inpatients at a major children's hospital in the Southwest USA. Records of children between 0-36 months of age that were born at term, and had no underlying disease were reviewed. Data extracted included demographics, history, PE, laboratory, and imaging studies. We documented the length of hospitalization, in-hospital consultations, and final diagnosis as well. Preliminary analysis of the 50 children (1/3 of the expected total) that met inclusion criteria show: Mean of 10.48 labs per patient (SD=5.967), mean of 1.8 images (SD=1.548), mean of 2.7 consultations (SD=1.356), and mean 6.24 days in hospital (SD=2.882). Final diagnosis was: Organic FTT in 20%; Non organic FTT in 36%; Mixes FTT in 4%, and 'Not determined' in 34%. Laboratory and imaging studies added contribution beyond history and PE in 12% of the patients. Of the combined total, 616 labs and imaging studies, 10 were contributory (1.6%). More laboratory tests were taken in children older than 6 months comparing to under 6 months infants (p<0.02; 95% CI 1, 9). There was no significant difference in number of imaging, consultations, or days of admission. Our preliminary results show that the history and PE remain central to the diagnosis of FTT with a similar percentage of contributory tests out of the total; however, labs and imaging studies helped to establish diagnosis in a relatively larger number of patients than the older literature showed.