Cognitive Bias in the Diagnosis of Kawasaki Disease
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MEDICINE
Cognitive Bias in the Diagnosis of Kawasaki Disease Aya Kondo 1 & Yoshiki Kusama 2
&
Ryo Kurozumi 3 & Masashi Kasai 1
Accepted: 18 August 2020 # Springer Nature Switzerland AG 2020
Abstract The diagnosis of Kawasaki disease (KD) is challenging as it requires the identification of specific signs and symptoms through physicians’ subjective evaluations. Thus, we aimed to evaluate the influence of cognitive bias on pediatricians’ identification of KD signs. Seventy-five pediatricians were randomly divided into two groups and asked to examine photographs of healthy children’s eye, tongues, and fingertips with different case histories suggesting either Kawasaki disease (KD) or the common cold. Of the 75 pediatricians, 28 responded to the questionnaire. The 14 pediatricians were given KD-suggestive histories; the others were given common cold-suggestive histories. The group that was given KD-suggestive histories was more likely to misdiagnose healthy children’s eye (85.7% vs 50.0%, p = 0.043), tongues (35.7% vs 7.1%, p = 0.065), and fingertips (85.7% vs 35.7%, p = 0.007) as positive KD signs in the photographs than that were given common cold-suggestive histories. We found that medical histories suggestive of KD can cause cognitive bias in physicians when identifying KD signs in photographs. Keywords Kawasaki disease . Cognitive bias . Diagnostic error . Decision making
Background Kawasaki disease (KD) is a common febrile disease of unknown etiology in East Asian infants and children that can progress to coronary artery disease (CAD), which has a major impact on long-term prognoses [1]. Although 20–25% of untreated KD patients develop CAD, the timely administration of intravenous immunoglobulin can reduce CAD incidence to less than 5% [2, 3]. As a consequence, early diagnosis is crucial for the prompt initiation of treatment in KD patients. However, the diagnosis of KD is challenging as it requires the
identification of specific signs and symptoms through physicians’ subjective evaluations. From a cognitive psychological perspective, many researchers suggested that diagnostic errors can occur during physicians’ subjective evaluations due to various biases (e.g., cognitive biases) [4–6]. Such errors can lead to overdiagnosis (resulting in unnecessary treatment) or diagnostic delay (resulting in the loss of treatment opportunities). This study aimed to evaluate the influence of cognitive bias on pediatricians’ identification of KD signs.
Methods This article is part of the Topical Collection on Medicine Electronic supplementary material The online version of this article (https://doi.org/10.1007/s42399-020-00469-9) contains supplementary material, which is available to authorized users. * Yoshiki Kusama [email protected] 1
Division of Infectious Disease, Department of Pediatrics, Kobe Children’s Hospital, Hyogo, Japan
2
AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
3
Graduate School of Comprehensive Human
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