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Published on: January 24, 2020
Age-related cognitive bias in in-hospital cardiac arrest
Mathias J Holmberg1, Asger Granfeldt2, Ari Moskowitz3
1Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark.
Insights
This study found no evidence that left-digit bias in patient age affects outcomes for in-hospital cardiac arrest. Survival rates remained consistent across age thresholds, indicating cognitive bias did not impact clinical decisions in this setting.
Area of Science:
- Medical Error and Patient Safety
- Cardiology and Critical Care Medicine
- Cognitive Psychology in Healthcare
Background:
- Cognitive bias can influence clinical decision-making and potentially lead to medical errors.
- Left-digit bias, a specific cognitive bias, involves overemphasizing the leftmost digit of a number, potentially affecting clinical judgment.
- Understanding the impact of cognitive bias on patient outcomes is crucial for improving healthcare quality.
Purpose of the Study:
- To investigate the influence of left-digit bias, specifically related to patient age, on outcomes following in-hospital cardiac arrest.
- To determine if age thresholds (e.g., 80 years) show a sudden change in survival rates, suggesting cognitive bias in clinical assessment.
- To analyze the association between cognitive bias and patient survival, return of spontaneous circulation, neurological outcome, and resuscitation duration.
Main Methods:
- Utilized the Get With The Guidelines® - Resuscitation registry, including adult patients with in-hospital cardiac arrest from 2011 to 2019.
- Employed a regression discontinuity design to assess survival changes around specific age thresholds (60, 70, 80, and 90 years).
- Primary outcome was survival to hospital discharge; secondary outcomes included return of spontaneous circulation, neurological outcome, and resuscitation duration.
Main Results:
- A total of 26,784 patients were analyzed, with an overall survival rate of 22%.
- No significant discontinuity in survival rates was observed below and above the age of 80 years (risk difference, 0.47%; 95% CI, -1.61% to 2.56%).
- Similar findings were consistent across secondary outcomes and other age thresholds, confirmed by sensitivity analyses.
Conclusions:
- The study found no evidence that cognitive bias related to patient age influences outcomes in patients experiencing in-hospital cardiac arrest.
- Clinical decision-making regarding cardiac arrest management did not appear to be significantly affected by left-digit bias in this large patient cohort.
- These findings suggest that age-related cognitive biases may not be a major confounder for patient outcomes in this specific critical care setting.
Aims:
Cognitive bias has been recognized as a potential source of medical error as it may affect clinical decision making. In this study, we explored how cognitive bias, specifically left-digit bias, may affect patient outcomes in in-hospital cardiac arrest.
Methods:
Using the Get With The Guidelines® - Resuscitation registry, we included adult patients with an in-hospital cardiac arrest from 2011 to 2019. The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation, favorable neurological outcome, and duration of resuscitation. Using a regression discontinuity design, we explored whether there was a sudden change in survival at the age threshold of 80 years which would indicate left-digit bias. Additional analyses were performed at age thresholds of 60, 70, and 90 years.
Results:
A total of 26,784 patients were included for the primary analysis. The overall survival was 22% in this cohort. There was no discontinuity of survival below and above the age of 80 years (risk difference, 0.47%; 95%CI, -1.61% to 2.56%). Similar results were estimated for the secondary outcomes and for the age thresholds of 60, 70, and 90 years. The results were consistent in sensitivity analyses.
Conclusions:
There was no indication that cognitive bias based on age affected outcomes in in-hospital cardiac arrest in these data.
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