Case study: 4 month old with constipation (S7 Ep. 51)

In the first case study of our mini-series on Cognitive Bias in Health Care, we meet a 4 month old female referred to the emergency department for constipation.  Spoiler alert: We know it's not constipation... so we explore how her presentation and physical exam clash with the initial medical decision making.  Try to spot the cognitive bias and test yourself on building a differential diagnosis.  Lastly, we explore 4 best practice techniques to help you avoid bias in the first place.  

References

Abimanyi-Ochom, J., Bohingamu Mudiyanselage, S., Catchpool, M., Firipis, M., Wanni Arachchige Dona, S., & Watts, J. J. (2019). Strategies to reduce diagnostic errors: a systematic review. BMC medical informatics and decision making, 19(1), 174. https://doi.org/10.1186/s12911-019-0901-1

Benninga, M. A., Faure, C., Hyman, P. E., St James Roberts, I., Schechter, N. L., & Nurko, S. (2016). Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology, S0016-5085(16)00182-7. https://doi.org/10.1053/j.gastro.2016.02.016

Bolick, B.N., Reuter-Rice, K., Madden, M.A., & Severin, P.A. (2021). Pediatric Acute Care: A Guide for Interprofessional Practice (2nd ed). Elsevier.

Centers for Disease Control and Prevention. (2021). Botulism: Diagnosis and treatment. https://www.cdc.gov/botulism/testing-treatment.html

Committee on Diagnostic Error in Health Care; Board on Health Care Services; Institute of Medicine; The National Academies of Sciences, Engineering, and Medicine; Balogh EP, Miller BT, Ball JR, editors. Improving Diagnosis in Health Care. Washington (DC): National Academies Press (US); 2015 Dec 29. 3, Overview of Diagnostic Error in Health Care. Available from: https://www.ncbi.nlm.nih.gov/books/NBK338594/

Ely, J. W., & Graber, M. A. (2015). Checklists to prevent diagnostic errors: a pilot randomized controlled trial. Diagnosis (Berlin, Germany), 2(3), 163–169. https://doi.org/10.1515/dx-2015-0008

Graber, M. L., Sorensen, A. V., Biswas, J., Modi, V., Wackett, A., Johnson, S., Lenfestey, N., Meyer, A. N., & Singh, H. (2014). Developing checklists to prevent diagnostic error in Emergency Room settings. Diagnosis (Berlin, Germany), 1(3), 223–231. https://doi.org/10.1515/dx-2014-0019

Marshall, T.L., Rinke, M.L., Olson, A.P.J., Brady, P.W. (2022). Diagnostic error in pediatrics: A narrative review. Pediatrics, 149 (Supplement 3): e2020045948D. 10.1542/peds.2020-045948D

O’Hagan, T., Fennell, J., Tan, K., Ding, D., & Thomas-Jones, I. (2019). Cognitive bias in the clinical decision making of doctors. Future Healthcare Journal, 6(1), s113.

Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., Benninga, M. A., European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, & North American Society for Pediatric Gastroenterology. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258–274. https://doi.org/10.1097/MPG.0000000000000266

The Canadian Medical Protection Authority. Common cognitive biases: Influences on decision making. Good Practices Guide. https://www.cmpa-acpm.ca/serve/docs/ela/goodpracticesguide/pages/human_factors/Cognitive_biases/common_cognitive_biases-e.html

Zabidi-Hussin Z. A. (2016). Practical way of creating differential diagnoses through an expanded VITAMINSABCDEK mnemonic. Advances in medical education and practice, 7, 247–248. https://doi.org/10.2147/AMEP.S106507