Cognitive Bias in the Diagnosis of Kawasaki Disease

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.