LETTER
Sensitivity and Specificity of the History and Physical Examination for Coronary Artery Disease
Arthur T. Evans, MD, MPH
15 February 1994 | Volume 120 Issue 4 | Pages 344-345
TO THE EDITOR:
Pryor and colleagues have written a very interesting article [1]; however, their data on sensitivity and specificity for each of the three diagnostic outcomes (significant disease, severe disease, and left main disease) are subject to verification or work-up bias. Their study sample included 1030 patients, but diagnostic outcomes were verified on only the 168 patients who subsequently had cardiac catheterization within 90 days. Because patients who "tested" positive (based on history and physical examination data) were more likely to have the gold standard evaluation (cardiac catheterization), the reported sensitivities are probably falsely high, and the reported specificities are probably falsely low.
The authors can correct for verification bias because they can calculate the "test" results within the group of patients who did not have the gold standard evaluation. I would be interested in seeing the corrected sensitivities and specificities for each of the three diagnostic test outcomes.
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Author and Article Information
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University of North Carolina at Chapel Hill; Chapel Hill, NC 27599
1. Pryor DB, Shaw L, McCants CB, Lee KL, Mark DB, Harrell FE Jr, et al. Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med. 1993; 118:81-90.
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