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Volume 338:767-769 March 12, 1998 Number 11
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Clinical Problem-Solving: High on the Differential

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by Lurie, J. D.
To the Editor: The commentary in the Clinical Problem-Solving article "High on the Differential" (Nov. 6 issue) 1 contains a misconception that, in my mind, illustrates very nicely why expert systems may sometimes lead to erroneous calculations of the likelihood of a diagnosis in a particular patient.

The underlying disease in the 48-year-old patient — chronic renal failure with several phases of dialysis treatment and three kidney transplantations — clearly has an impact on the pretest probability of coronary artery disease. Although chronic uremia is not a conventional risk factor for coronary artery disease, the estimated prevalence of coronary artery disease . . . [Full Text of this Article]

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