# Sprains, Strains and Growing Pains: Managing Cognitive Bias to Facilitate Timely Diagnosis in Pediatric Sports Medicine

## TL;DR

This paper discusses how cognitive biases in doctors can delay diagnoses in young athletes, using three case studies to show the impact and suggest ways to improve decision-making.

## Contribution

The paper introduces practical strategies to manage cognitive biases in diagnosing atypical pediatric sports injuries.

## Key findings

- An atypical celiac disease case was misdiagnosed as growing pains due to anchoring and confirmation bias.
- Chronic exertional compartment syndrome was misattributed to soreness due to ascertainment bias.
- A vertebral mass was misdiagnosed as a shoulder strain due to anchoring and ascertainment bias.

## Abstract

Background: Diagnostic delay and error represent pervasive problems in healthcare with grave implications for treatment and prognosis. Though characteristic of human cognition, cognitive biases commonly contribute to delays in the physician decision-making process, particularly in atypical or complex presentations in youth. Methods: We present a case series of three adolescent athletes with varied clinical presentations whose diagnostic conceptualization and treatment were delayed in part due to cognitive biases with consequences for overall health and development, as well as return to sport. Results: The first case depicts how an atypical presentation of celiac disease was attributed to growing pains, illustrating the contribution of anchoring bias and confirmation bias in medical decision making. The second case represents the misattribution of chronic exertional compartment syndrome pain to growing pains and post-exercise soreness, highlighting the influence of ascertainment bias on the initial misdiagnosis. The third case describes how a vertebral mass was misdiagnosed as a left shoulder strain from weightlifting, depicting the contribution of anchoring bias and ascertainment bias in medical decision making. Conclusions: Early recognition of cognitive biases, including confirmation bias, anchoring bias, and ascertainment bias, is crucial for improving medical decision making, particularly in cases of rare or atypical presentations, reducing unnecessary diagnostic delays, and setting more realistic patient expectations. Through discussion of these cases, we highlight concrete steps to manage bias to facilitate timely diagnosis within the primary care and sports medicine setting.