Hidden diagnosis behind viral infection: the danger of anchoring bias.

Authors:
Kenji Iwai
Kenji Iwai
Kobe University Graduate School of Medicine
Kenichi Tetsuhara
Kenichi Tetsuhara
National Center for Child Health and Development
Mitsuru Kubota
Mitsuru Kubota
Teine Keijinkai Hospital

BMJ Case Rep 2018 Oct 21;2018. Epub 2018 Oct 21.

Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.

Anchoring bias is one of the most common diagnostic biases that may lead to closed-minded thinking and could result in unnecessary tests, inappropriate patient management and even misdiagnosis. A 4-year-old boy was brought to the emergency department because of shaking chills. On the basis of bilateral swollen preauricular areas, high level of serum amylase and the prevalence of mumps, he initially received a diagnosis of mumps in spite of the shaking chills. However, blood culture turned out to be positive for two different kinds of bacteria. The patient finally received a diagnosis of polymicrobial bacteraemia resulting from suppurative appendicitis. We must consider and rule out bacteraemia in the differential diagnosis for patients who present with shaking chills, even in the presence of symptoms or information consistent with a more common viral infection such as mumps. In addition, intra-abdominal infection should be ruled out in the presence of polymicrobial enterobacteriaceae bacteraemia.

Download full-text PDF

Source
http://dx.doi.org/10.1136/bcr-2018-226613DOI Listing
October 2018
9 Reads

Publication Analysis

Top Keywords

shaking chills
12
received diagnosis
8
viral infection
8
anchoring bias
8
chills blood
4
spite shaking
4
diagnosis mumps
4
mumps spite
4
blood culture
4
turned positive
4
patient finally
4
bacteria patient
4
kinds bacteria
4
positive kinds
4
culture turned
4
mumps initially
4
preauricular areas
4
swollen preauricular
4
bilateral swollen
4
basis bilateral
4

Similar Publications