Few studies have directly compared the performance of computer decision aids to the judgment of the experts they purport to aid. Accordingly, we compared the accuracy of two computer programs designed to interpret exercise electrocardiography and myocardial perfusion scintigraphy with respect to suspected coronary artery disease- one based on a mathematical algorithm and the other on a set of heuristic rules - with a variety of clinical cardiologists. A total of 45 hypothetical cases consisting of a clinical history, exercise heart rate, exercise blood pressure, maximal ST-segment depression and slope, and the number and severity of myocardial perfusion defects were interpreted by 21 clinicians and by each decision aid. Intraobserver variability for clinician interpretations averaged 6%, and interobserver variability averaged 12%. Using the average clinician interpretation for each case as a reference standard, the accuracy of the algorithmic and heuristic programs were identical (86%), suggesting that both approaches are equally applicable to circumscribed clinical problems such as this.

Keywords:
Clinical judgment, Computer-aided diagnosis, Coronary artery disease, Stress testing
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1988
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