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Clinical Information: An Indispensable Component of ECG Interpretation-Reply

Patrick M. Dunn, MD; Wendy Levinson, MD
Arch Intern Med. 1991;151(6):1236. doi:10.1001/archinte.1991.00400060140031.
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In Reply. —  In response to the comments of Grauer et al concerning our study1 recently published in the ARCHIVES, we recognize the variability of electrocardiographic interpretation, but would have expected some alteration of readings with the provision of clinical information. However, no significant differences in the frequency or direction of change in interpretation among cardiologists were found.Generally, the provision of clinical information to the interpreter of a diagnostic test is not recommended.2,3 The interpreter, entrapped by prior expectation, tends to find what is expected or hoped to be found. This biasing of interpretation increases the agreement between the test and the standard of validity. The test is made to seem more useful than it actually is. In contrast to this prior belief, in the specific circumstances of our study, the addition of clinical information did not result in changes in electrocardiographic reading. Because of our results,


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