Background: The complexity of decision-making and diversity of tasks in pediatric practice can lead to medical errors. To confirm the hypothesis that physicians’ emotions influence the occurrence of medical errors, we analyzed medical adverse event reports to assess the effect of emotional factors on pediatrician decision-making and medical errors. Methods: This study involved case analyses of reports of pediatrician-related medical adverse events drawn from a Japanese national medical database. We examined 310 adverse medical event reports involving pediatrician errors recorded over a 6-year period. Reports involving decision-making errors were extracted and analyzed by the patient’s age, doctor’s experience, severity of the adverse event, event circumstances, timing of errors by decision-making stage, and the presence of emotional factors. Results: We found decision-making errors in 58.6% of the examined medical adverse events reports. Most errors occurred in the situation awareness and decision stages. Overall, 53.2% of cases involving decision-making errors showed emotional involvement in the adverse event occurrence. The three emotional factors that most affected errors were trust, optimism, and distraction. Conclusions: Over half of the cases of errors in the decision-making process had an emotional component. The finding that trust influenced medical errors suggests that even positive emotions may affect errors. More awareness of the emotional aspects of clinical decision-making and research approaches that address emotion will help to reduce medical errors and improve patient safety.

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The patient was 12-year-old girl, who was admitted to our hospital with gait disturbance and involuntary movements that had appeared 7 days prior. Laboratory tests revealed elevated levels of serum anti-streptolysin O and anti-streptokinase titers. Doppler Color Echocardiography also showed mild mitral and tricuspid regurgitation. The patient exhibited the following required criteria: two major diagnostic criteria of Sydenham chorea and subclinical carditis; one minor diagnostic criteria of arthralgia. The Jones Criteria for Diagnosis of Rheumatic Fever was fulfilled after admission. Recently rheumatic fever has been decreasing rapidly in well-developed countries. It is believed that there may be many undiagnosed cases because the diagnostic criteria are unfulfilled when the symptoms of Sydenham’s chorea appear. We propose that it is necessary to consider rheumatic fever with carditis in the presence of Sydenham’s chorea.

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A 73-year-old man had undergone treatment for diabetes mellitus, hypertension, and dyslipidemia in another hospital. He was referred to our hospital after monoclonal immunoglobulinemia was discovered during a routine medical examination. He was diagnosed with multiple myeloma (immunoglobulin G [IgG]-κ type, Durie–Salmon stage IIA, International Staging System stage I) and was observed without therapy. However, because of an increasing IgG level (6,715 mg/dl), treatment with once-weekly intravenous bortezomib at 1.3 mg/m2 was initiated. Two days after the sixth bortezomib administration, he complained of frequent vomiting, and the diagnosis of paralytic ileus was made. Because bortezomib-induced ileus was suspected, the bortezomib was discontinued thereafter. Bortezomib-induced paralytic ileus has been reported in patients treated with vincristine and/or thalidomide as well as those undergoing twice-weekly bortezomib administration. Clinicians should be aware that once-weekly bortezomib can induce ileus in patients without previous treatment.

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We report a case of warm-type autoimmune hemolytic anemia (AIHA) associated with systemic lupus erythematosus (SLE), wherein the patient was suspected to have AIHA caused by cold agglutinin disease (CAD) at the first visit. The patient was eventually diagnosed with warm-type AIHA and her condition improved following treatment. The patient was a 66-year-old woman who was admitted to another hospital for angina. After the angina improved, she was diagnosed with Coombs-positive hemolytic anemia and CAD with a cold agglutinin titer of 256x, in addition to breast cancer and duodenal cancer. Because no hematology specialist was available in the previous hospital, the patient was transferred to our hospital. The patient was diagnosed with AIHA caused by low-titer CAD and administered warm blood transfusion, which was ineffective. Irregular antibodies were detected and irregular antibody-compatible blood was used for transfusion; however, the hemolysis reaction worsened and the result of a direct anti-globulin test indicated warm-type antibody AIHA. Thereafter, the patient tested positive for anti-cardiolipin antibodies in addition to anti-nuclear and anti-DNA antibodies and her lymphocyte count was less than 1,000/μl; therefore, the patient was diagnosed with SLE. Treatment with prednisolone 1 mg/kg improved the various symptoms including anemia. This case presents interesting findings regarding causative diseases of secondary hemolytic anemia.

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A 52-year-old man was admitted to our hospital 18 hours after the sudden onset abdominal pain and vomiting. Abdominal distention and pain at the site of his scar of past operation for appendicitis was observed. Abdominal computed tomography revealed dilated small intestine and incarcerated incisional hernia. Laparoscopic surgery was performed under the diagnosis of an incarcerated incisional hernia with ileus. After the incarcerated small intestine was released by opening the hernia orifice with an ultrasonically activated scalpel, the small intestine was viable and needed no resection. The hernia orifice was repaired with intraperitoneal on-lay mesh with a double crown tacking technique. The postoperative period was uneventful and the patient was discharged without any complications on the 6th postoperative day. No recurrence has been observed during follow-up. Laparoscopic surgery is useful for incarcerated incisional hernia because it simultaneously enables accurate diagnosis, evaluation of the viability of the incarcerated organ and repair of the hernia orifice.

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Patient was a 6-year-old boy, who was admitted to our hospital with fever persisting for more than 2 weeks. After admission, he had no clinical symptoms other than the fever. On the 24th day after the onset of fever, the patient developed bladder and bowel dysfunction and gait disturbance. Cerebrospinal fluid analysis showed pleocytosis, and the IgG index was elevated. From his clinical and laboratory findings, he was diagnosed with transverse myelitis. Two courses of methyl-prednisolone pulse therapy were administered. After treatment, his symptoms improved without neurological sequelae. Autoimmune neuropathy usually progresses rapidly, but our case shows that it can sometimes progress subacutely. Transverse myelitis should be considered as one of the causes for prolonged fever.

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