BMJ Case Reports 2011; doi:10.1136/bcr.08.2011.4594
  • Learning from errors

The pitfalls of premature closure: clinical decision-making in a case of aortic dissection

  1. Suresh Kumar2
  1. 1Saba University School of Medicine, Devens, Massachusetts, USA
  2. 2Department of Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, USA
  1. Correspondence to Bharat Kumar, bharatk{at}


Premature closure is a type of cognitive error in which the physician fails to consider reasonable alternatives after an initial diagnosis is made. It is a common cause of delayed diagnosis and misdiagnosis borne out of a faulty clinical decision-making process. The authors present a case of aortic dissection in which premature closure was avoided by the aggressive pursuit of the appropriate differential diagnosis, and discuss the importance of disciplined clinical decision-making in the setting of chest pain.


  • Competing interests None.

  • Patient consent Obtained.

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