The Lack of Effect of Clinical Information on Electrocardiographic Diagnosis of Acute Myocardial Infarction

doi:10.1001/archinte.1990.00390200101019

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Vol. 150 No. 9, September 1990

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The Lack of Effect of Clinical Information on Electrocardiographic Diagnosis of Acute Myocardial Infarction

Patrick M. Dunn, MD; Wendy Levinson, MD

Arch Intern Med. 1990;150(9):1917-1919.

Abstract

• It is widely held that the interpretation of a diagnostictest can be biased by clinical information. Many cliniciansare cautious about providing information that may bias testinterpretation and result in the decreased utility of the test.We quantitatively assessed the effect of clinical informationon electrocardiogram (ECG) interpretation of acute myocardialinfarction (AMI). Three cardiologists were asked to give independentwritten interpretations of 52 ECGs devoid of clinical information.Three weeks later, the same set of ECGs was reinterpreted withclinical information that was either strongly or mildly suggestiveof AMI. Of the 156 pooled ECGs, 22 changes (14%) in interpretationwith the addition of clinical information were made. Eleven(50%) of the changes were from negative to positive, and 11were from positive to negative. Changes in interpretation werenot affected by the nature of the clinical information or bywhether the ECG was typical for AMI. No significant changesin the sensitivity or specificity with the addition of clinicalinformation were present. This study did not demonstrate theanticipated effect of clinical information on the ECG interpretationof AMI. Interpretation of other tests may also be unaffectedby the provision of clinical information.

(Arch Intern Med. 1990;150:1917-1919)

Author Affiliations

From the Internal Medicine Training Program and the Department of Medicine, Good Samaritan Hospital and Medical Center and Oregon Health Sciences University, Portland.

Footnotes

Accepted for publication April 6,1990.

Reprints not available.

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