Samuel H. Zwillich, MD
Potential Financial Conflicts of Interest: None disclosed.
Zwillich S.; Where Is the Evidence That the Resurgence of Nomograms Is Harmful?. Ann Intern Med. 2009;150:282. doi: 10.7326/0003-4819-150-4-200902170-00016
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Published: Ann Intern Med. 2009;150(4):282.
TO THE EDITOR:
The review by Grimes (1) of the history of nomograms was informative. However, his criticism of the “epidemic” of nomogram resurgence was fundamentally unsubstantiated. Grimes states that “nomograms provided speed in calculation at the cost of precision” without providing any evidence that the lost precision mattered. Where is the evidence, for example, that calculating likelihood ratios to additional decimal places improves clinical decision making? Conversely, where is the evidence that calculating medication doses by using a body surface area nomogram adversely affects patient well-being?
An alternative, testable hypothesis is that contemporary reliance on computer-generated values numbs physicians to the meaning of their calculations and blinds them to errors that would have been obvious on a nomogram. Personal computing may be more convenient than nomograms, but inconvenience does not equal inappropriateness (“Hence, the resurgence of this relic is inappropriate”).
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