Cognitive Bias in Inpatient Pediatrics

[摘要] The contribution of cognitive bias toward diagnostic error has been well documented.1–7 Previous research exploring the effects of these cognitive pitfalls centers on examples from internal and emergency medicine, but it is fair to presume that pediatric hospitalists remain equally vulnerable to such cognitive error.8 To improve the overall awareness of cognitive bias within inpatient pediatrics, we present 2 cases that serve to illustrate some of the many cognitive biases a pediatrician may encounter in inpatient practice. We conclude with strategies to avoid the effects of cognitive bias on diagnostic accuracy.A 3-year-old male with no significant medical history presented to the emergency department (ED) with 11 days of a limp and 10 days of fever. His review of systems was otherwise positive for intermittent abdominal pain, increased loose stool, and a 3-pound weight loss. On examination, he had no point tenderness or swelling or erythema over either extremity; results of his neurologic examination were normal. The patient’s laboratory work was significant for a white blood cell count of 18.9 × 103/ μ L, hemoglobin of 10.8 g/dL, erythrocyte sedimentation rate of 65 mm/h, and C-reactive protein of 51.5 mg/L. Given the patient’s fever, limp, and elevated inflammatory markers, the inpatient team began an evaluation for osteomyelitis. A bone scan was positive in the area of the left lateral femoral condyle, and a follow-up MRI revealed inflammatory changes in the medial femoral metaphysis and epiphysis. He was diagnosed with osteomyelitis and was discharged from the hospital on intravenous antibiotics. Two weeks later, the patient presented with worsening abdominal pain, loose stool, and continued elevation in his inflammatory markers. A colonoscopy was performed and revealed evidence of Crohn’s disease. On review, the inflammatory changes seen previously on the MRI were consistent with chronic recurrent multifocal …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob