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All That Wheezes Is Not Asthma: Cognitive Bias in Pediatric Emergency Medical Decision Making

Park, Daniel B. MD; Dobson, Joseph V. MD; Losek, Joseph D. MD

doi: 10.1097/PEC.0000000000000065
Illustrative Cases

Objective The objectives of this study were to highlight the intimate role that cognitive biases play in clinical decision making in the pediatric emergency department and to recommend strategies to limit their negative impact on patient care outcomes.

Methods This was a descriptive study of 3 cases of presumed asthma exacerbation evolving into alternate diagnoses.

Results The role cognitive biases played in either delay to diagnosis or missed diagnosis contributing to patient morbidity are illustrated in each case.

Conclusions Common cognitive biases play a role in the unique milieu of the pediatric emergency department. A case series of presumed patients with asthma illustrates how mental shortcuts (heuristics) taken in times of high decision density and uncertainty may lead to diagnostic errors and patient harm. Suggestions to address and prevent cognitive biases are presented.

From the Medical University of South Carolina, Pediatric Emergency Medicine, Charleston, SC.

Disclosure: The authors declare no conflict of interest.

Reprints: Daniel B. Park, MD, The Medical University of South Carolina, Pediatric Emergency Medicine, 135 Rutledge Ave, Charleston, SC 29425 (e-mail:

© 2014 Lippincott Williams & Wilkins, Inc.