{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:56:03Z","timestamp":1790571363310,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007475","name":"Canadian Dermatology Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007475","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Dermatology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the most diagnostically challenging pediatric dermatology cases with respect to interpretation difficulty and diagnostic confusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a multi\u2010center prospective cross\u2010sectional study. A convenience sample of pediatric trainees and attendings was eligible. Using a web\u2010based tool, physicians diagnosed 334 pediatric dermatology image\u2010based cases. Participants assessed whether each case was concerning, selected one of nine morphologic categories, and chose one of 35 specific diagnoses. We extracted participant responses and analyzed the data using one\u2010parameter item response theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We enrolled 242 pediatric postgraduate trainees (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009105) and attendings (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009137) who completed 38,502 observations. There was no difference in the mean interpretation difficulty logit score between the diagnostic assignment of concerning (\u22121.6) versus nonconcerning (\u22121.3) cases; difference \u22120.3 (95% CI: \u22120.8, 0.2). However, there were significant differences in difficulty scores between morphological types (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and specific diagnoses (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Vesiculobullous and papulosquamous were the most difficult morphologies to classify correctly, while vascular and purpuric\/petechial were the easiest. The most challenging diagnoses were herpetic infections, bullous variants of impetigo, contact dermatitis, arthropod bites, and nonspecific viral exanthems. The easiest were injury\u2010related bruising, pernio\u2010COVID toes, and hemangiomas. There were 20\/35 (57.1%) skin conditions that demonstrated relatively frequent confusion with other skin conditions, 12\/20 (60%) of which would have implications for management.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study provides a comprehensive data\u2010driven assessment of diagnostic challenges in pediatric dermatology across morphologies and diagnoses. Substantial diagnostic difficulty and confusion were observed for numerous diagnoses, many with potential patient safety consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pde.70211","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T07:12:53Z","timestamp":1779779573000},"page":"1089-1097","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Challenges in Pediatric Dermatologic Presentations Among Pediatricians"],"prefix":"10.1111","volume":"43","author":[{"given":"Kathy","family":"Boutis","sequence":"first","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics Hospital for Sick Children and University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5236-6598","authenticated-orcid":false,"given":"Martin","family":"Pusic","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics Boston Children's Hospital, Harvard University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Division of Pediatric Dermatology, Department of Pediatrics Hospital for Sick Children and University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Gupta","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics Hospital for Sick Children and University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9598-5046","authenticated-orcid":false,"given":"Madeline","family":"Bell","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolas","family":"MacLellan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Bobotsis","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashie","family":"Brar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9288-1121","authenticated-orcid":false,"given":"Cathryn","family":"Sibbald","sequence":"additional","affiliation":[{"name":"Division of Pediatric Dermatology, Department of Pediatrics Hospital for Sick Children and University of Toronto  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1470.1994.tb00586.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.4414\/smw.2013.13731"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2016.01.021"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2016.02.1219"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2003.06.009"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.12362"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdds.2016.05.003"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2024.114436"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/10401334.2020.1754216"},{"key":"e_1_2_10_11_1","first-page":"1231","article-title":"Learning Analytics to Enhance Dermatopathology Education Among Dermatology Residents","volume":"18","author":"Mu E. W.","year":"2019","journal-title":"Journal of Drugs in Dermatology"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2923.2003.01587.x"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ced\/llae063"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.17127"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2018.12.072"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/01461672992512005"},{"key":"e_1_2_10_17_1","article-title":"Image Interpretation: Learning Analystics Based Education Opportunities","volume":"5","author":"Thau E.","year":"2021","journal-title":"Academic Emergency Medicine Education and Training"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10459-018-9846-x"},{"key":"e_1_2_10_19_1","first-page":"269","article-title":"Building Emergency Medicine Trainee Competency in Pediatric Musculoskeletal Radiograph Interpretation: A Multicenter Prospective Cohort Study","volume":"3","author":"Lee M. S.","year":"2019","journal-title":"Academic Emergency Medicine Education and Training"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2024.114183"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2014.11.016"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1071\/HC20046"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.4300\/JGME-D-14-00601.1"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10459-020-09963-0"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/pde.12714"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-023-02728-3"}],"container-title":["Pediatric Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pde.70211","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/pde.70211","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pde.70211","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T04:25:05Z","timestamp":1790569505000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pde.70211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1111\/pde.70211"],"URL":"https:\/\/doi.org\/10.1111\/pde.70211","archive":["Portico"],"relation":{},"ISSN":["0736-8046","1525-1470"],"issn-type":[{"value":"0736-8046","type":"print"},{"value":"1525-1470","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"2025-10-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}