{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:36:42Z","timestamp":1786117002781,"version":"build-2736575974"},"reference-count":21,"publisher":"Walter de Gruyter GmbH","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_dx-2025-0057_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Missed opportunities for diagnostic excellence are common and can lead to delayed diagnoses and initiation of treatment. Medical teams incorporate many elements into the diagnostic process, including patient factors, medical knowledge, data gathering, care environment, subspecialized personnel, and hospital processes. A case-based discussion describes how search satisfying\u00a0\u2013\u00a0the tendency to stop searching once something has been found\u00a0\u2013\u00a0and authority gradients can lead to delays in diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0057_abs_002\">\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 2-year-old girl repeatedly presents to the emergency department with vomiting and periorbital swelling progressing to esotropia, initially found to have normal short-sequence MR brain imaging. After nonspecific labs and reassuring initial imaging, ophthalmologic consultation obtained during the child\u2019s third emergency department visit proposed plausible diagnoses of benign post-viral esotropia or decompensated esotropia. When her exam worsened at ophthalmology clinic follow up, she was referred back to the emergency department for complete MR brain and orbit imaging leading to a diagnosis of bilateral orbital myositis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0057_abs_003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Examining the diagnostic process through integrated commentary, this case emphasizes the importance of recognizing limitations of short-sequencing advanced imaging and continuing the diagnostic pursuit in collaboration with consultants. A fishbone diagram visually demonstrates the factors that lead to a missed opportunity for diagnostic excellence. The case concludes with clinical teaching points in addition to a pitfall, myth, and pearl specific to search satisfying and authority gradients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/dx-2025-0057","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T10:56:28Z","timestamp":1761044188000},"page":"326-331","source":"Crossref","is-referenced-by-count":0,"title":["Lessons in clinical reasoning\u00a0\u2013\u00a0pitfalls, myths, and pearls: how search satisfying can keep eyes crossed"],"prefix":"10.1515","volume":"13","author":[{"given":"Margaret E.","family":"Tashjian","sequence":"first","affiliation":[{"name":"Pediatric Emergency Medicine , 2932 Children\u2019s Hospital Colorado , Aurora , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Parker","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Medicine , 2932 Children\u2019s Hospital Colorado , Aurora , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca G.","family":"Edwards Mayhew","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology , University of Colorado School of Medicine , Aurora , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halden F.","family":"Scott","sequence":"additional","affiliation":[{"name":"Pediatrics , University of Colorado Anschutz Medical Campus , Aurora , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Grubenhoff","sequence":"additional","affiliation":[{"name":"Pediatrics , University of Colorado Denver School of Medicine , Aurora , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"2026080612585085473_j_dx-2025-0057_ref_001","doi-asserted-by":"crossref","unstructured":"Harel, S, Mallon, M, Langston, J, Blutstein, R, Kassutto, Z, Gaughan, J. 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