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Clinical Information: An Indispensable Component of ECG Interpretation

Ken Grauer, MD; R. Whit Curry JR, MD; Marvin Dewar, MD
Arch Intern Med. 1991;151(6):1232-1236. doi:10.1001/archinte.1991.00400060140030.
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To the Editor.—  We read with interest the article by Dunn and Levinson1 that appeared in the September issue of the ARCHIVES. We were, however, concerned by both the methodology, and the conclusions of the authors. No mention was made in the article of the well-known inter- and intraobserver variability in electrocardiographic (ECG) interpretation (of 10% to 30%), even among experts! Failure to account for this might significantly alter the results obtained.The data given indicated that 11 of the 22 changes were from positive to negative, and 11 were from negative to positive. The interpretation of these data was that provision of clinical information did not affect the interpretation of the ECG. While this may be the overall result, it does not rule out possible benefit in interpretation of an individual case. For example, imagine a patient with an ECG that demonstrates J-point ST segment elevation suggestive of


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