69.2 DISTORTED COGNITION: A CLINICAL EXAMPLE FROM A PEDIATRIC ACUTE CARE EXPERIENCE

Abstract

Objectives: This case study illustrates the complexities of evaluation and care of delirium symptoms in a hospital-based, acute care setting. Methods: A detailed review of case data is performed, with a focus on cognition, and is summarized for presentation. Results: This is an anonymized case example of an elementary school–aged patient who developed a several-day onset of “behavioral difficulties” that were noted by parents and teachers. This young patient presented with affective, cognitive, and behavioral symptoms, which had puzzled, concerned, and confused the community and hospital healthcare professionals from pediatrics, family medicine, pediatric neurology, emergentology, and pediatric psychiatry. The symptom profile and clinical impressions raised the concern for anxiety. Key contextual factors included the COVID-19 pandemic, and related environmental and schooling changes. The clinical team ultimately diagnosed and treated the delirium syndrome and the primary encephalopathic illness. Persisting cognitive challenges are elaborated. Conclusions: The patient’s illness evolution and presentation were perplexing for the family, school, and healthcare teams, complicated by the cognitive changes associated with the child’s syndrome of delirium. The case review provides an opportunity to identify challenges inherent to the assessment and treatment of distorted cognition in acute illness and thereafter. There is emphasis on the value of interprofessional collaborations in the care practices given such clinical scenarios, with attention to risk for potentially negative impacts on illness management and outcomes. COG, DIAG, NEPSYC