Location
Suwanee, GA
Start Date
7-5-2024 1:00 PM
End Date
7-5-2024 4:00 PM
Description
INTRODUCTION:
Cerebral palsy (CP) is the most common cause of neurological and motor disability in the pediatric population, and manifests with varying degrees of severity. Due to complications involving motor, functional, and cognitive impairment, patients with severe CP generally experience a shorter life expectancy. Over the past 30 years however, mortality rates have declined and most children with CP survive into adulthood. The recent trend of increased life span in this population presents an interesting phenomenon in which patients in their 20’s must transfer from the familiarity and comfort of pediatric care into adult care. PCPs inheriting these patients may have different levels of experience managing CP and its complications. This case emphasizes the unique challenges faced during this transition period, including decreased compliance with routine healthcare visits, delayed or misdiagnosis due to communication barriers, and developing rapport among patient, caregiver, and physician.
CASE SUMMARY:
A 27-year-old wheelchair-bound, nonverbal female with CP is brought to the ED by her mother due to progressive right abdominal pain for one month. The pain is constant and aggravated when transferring with assistance. Over-the-counter NSAIDs seem to help, as she will stop crying temporarily. Of note, the patient aged out of pediatric care two years ago and has yet to find a PCP with whom she feels comfortable; therefore her family has largely relied on the ED to manage her healthcare. Vitals are within normal ranges. The patient is alert, nonverbal, and appears to be moderately distressed sitting in decorticate posturing in her wheelchair. CBC, CMP, lipase, and urinalysis are unremarkable. Not knowing the source of her symptoms, she was prescribed antibiotics for a suspected UTI and referred to a PCP for outpatient care. However, one month later she returns to the ED for persisting symptoms, during which time an abdominal x-ray reveals a subacute right pelvic fracture. She was given appropriate pain medication and her symptoms resolved with conservative management.
DISCUSSION:
There is an abundance of literature identifying the gap in medical care that exists for adults living with CP. However, this case provides a unique example of a patient’s prolonged suffering and delayed diagnosis as a result of the interruption in healthcare. From an osteopathic perspective, a person is a unit of body, mind, and spirit; and failure to address this patient’s mental concerns of re-establishing a medical home with an adult PCP ultimately led to failure in managing her physical ailments. Utilizing this holistic approach can help bridge the gap in care between pediatric and adult CP care, and should be particularly emphasized in medical residency and fellowship programs. Areas of improvement should also be focused on a formal and prolonged pediatrician-to-PCP patient hand-off, which should ideally begin early in adolescence around 12 to 14-years-old, instead of delaying a rushed transition during the patient’s twenties.
Embargo Period
7-2-2024
Included in
Delayed diagnosis of pelvic fracture in a 27-year-old with cerebral palsy: A Case Report
Suwanee, GA
INTRODUCTION:
Cerebral palsy (CP) is the most common cause of neurological and motor disability in the pediatric population, and manifests with varying degrees of severity. Due to complications involving motor, functional, and cognitive impairment, patients with severe CP generally experience a shorter life expectancy. Over the past 30 years however, mortality rates have declined and most children with CP survive into adulthood. The recent trend of increased life span in this population presents an interesting phenomenon in which patients in their 20’s must transfer from the familiarity and comfort of pediatric care into adult care. PCPs inheriting these patients may have different levels of experience managing CP and its complications. This case emphasizes the unique challenges faced during this transition period, including decreased compliance with routine healthcare visits, delayed or misdiagnosis due to communication barriers, and developing rapport among patient, caregiver, and physician.
CASE SUMMARY:
A 27-year-old wheelchair-bound, nonverbal female with CP is brought to the ED by her mother due to progressive right abdominal pain for one month. The pain is constant and aggravated when transferring with assistance. Over-the-counter NSAIDs seem to help, as she will stop crying temporarily. Of note, the patient aged out of pediatric care two years ago and has yet to find a PCP with whom she feels comfortable; therefore her family has largely relied on the ED to manage her healthcare. Vitals are within normal ranges. The patient is alert, nonverbal, and appears to be moderately distressed sitting in decorticate posturing in her wheelchair. CBC, CMP, lipase, and urinalysis are unremarkable. Not knowing the source of her symptoms, she was prescribed antibiotics for a suspected UTI and referred to a PCP for outpatient care. However, one month later she returns to the ED for persisting symptoms, during which time an abdominal x-ray reveals a subacute right pelvic fracture. She was given appropriate pain medication and her symptoms resolved with conservative management.
DISCUSSION:
There is an abundance of literature identifying the gap in medical care that exists for adults living with CP. However, this case provides a unique example of a patient’s prolonged suffering and delayed diagnosis as a result of the interruption in healthcare. From an osteopathic perspective, a person is a unit of body, mind, and spirit; and failure to address this patient’s mental concerns of re-establishing a medical home with an adult PCP ultimately led to failure in managing her physical ailments. Utilizing this holistic approach can help bridge the gap in care between pediatric and adult CP care, and should be particularly emphasized in medical residency and fellowship programs. Areas of improvement should also be focused on a formal and prolonged pediatrician-to-PCP patient hand-off, which should ideally begin early in adolescence around 12 to 14-years-old, instead of delaying a rushed transition during the patient’s twenties.