Cognitive bias and diagnostic overshadowing in trauma: Substance use disorder effects on surgical intervention timing in traumatic brain injury patients

This study examines diagnostic overshadowing—a cognitive bias where pre-existing conditions obscure recognition of other diagnoses—by analyzing how substance and alcohol use disorders affect time to surgery in traumatic brain injury patients. Using data from 15,207 TBI patients requiring neurosurgery, researchers found patients with substance use disorders experienced delayed surgical intervention (mean 46.7 hours vs 32.4 hours) and worse outcomes, suggesting clinician bias may compromise care quality in this population.