Cognitive Bias in Emergency Radiology: Implications for Trauma Torso CT

As the volume and complexity of trauma torso Computed Tomography (CT) scans continue to rise, the risk of diagnostic error in the emergency department (ED) remains a significant challenge. While perceptual misses are common, in the high acuity and time-pressured environment of the ED, many errors are driven by ingrained mental shortcuts that can lead to misinterpretation, ie, cognitive biases. This educational review presents 16 cases from a level 1 trauma and tertiary care institution, emphasizing diagnostic errors and near-misses encountered during the interpretation of emergency torso CT. Cases are organized by organ systems and highlight missed or misinterpreted findings involving the cardiothoracic, gastrointestinal, genitourinary, and musculoskeletal systems. Each case illustrates a relevant cognitive bias, including framing bias, satisfaction of search, anchoring bias, premature closure, availability bias, zebra retreat bias, and blind spot bias. The pathophysiology of these commonly overlooked injuries will be reviewed with a focus on cognitive biases that lead to their omission and practical mitigation strategies to avoid them. This review emphasizes the importance of reviewing all available images independently with a systematic and consistent search pattern and only then integrating clinical information as a potential strategy to reduce cognitive biases. By recognizing these patterns of error and implementing mitigation strategies, radiologists may improve diagnostic accuracy and clinical outcomes.