Name
The medical application that will be critically appraised is The Chief Complaint.
Author
The application The Chief Complaint was created by Dr. Chris Feier, MD, who is an Assistant Professor of Clinical Emergency Medicine at the Keck School of Medicine at Los Angeles County (LAC) + USC Medical Center, as well as at the University of Southern California. Various physicians contributed to different sections of the app. The individuals responsible for editing the information on the application are Dr. Craig Torres-Ness, M.D., and Dr. Erik Akopian, M.D. The content within the app was provided by Max Fitzgerald, M.D., Ariel Bowman, M.D., Ryan Raam, M.D., and Brian Doane, M.D. Illustrations were supplied by Sonia Johnson, M.D., and the drug index was compiled by Helen Lee, PharmD (The Chief Complaint, 2022).
Endorsement
The application does not list any official endorsements or licenses. However, the content is referenced from Los Angeles County (LAC) + USC Medical Center and Keck School of Medicine, with the application being recommended by physicians who have graduated from these institutions. ESCAVO is the developer and endorser of the application (The Chief Complaint, 2022).
Operation
The Chief Complaint application is available for both Android and Apple devices and can be utilized on mobile phones, tablets, or iPads. The application is user-friendly and designed to be straightforward, especially for emergency providers who need quick access to information. The app pulls information from various sources and provides hyperlinks for more detailed information.
Aesthetics
The application is visually organized, with each body system labeled and colored. For example, cardiology is represented by a heart icon, and neurology by a brain icon. At the bottom of the screen, there is a horizontal section featuring three areas: drugs, calculators (including tools like the Glasgow Coma Scale and Wells criteria for PE), and a reference section (The Chief Complaint, 2022). Additionally, there is a bookmark section for storing saved information, a notes section, and a search button for finding specific content within the app.
Purpose
The purpose of The Chief Complaint app is to support healthcare professionals by providing information on common complaints. Upon opening the app, a disclaimer states that the information is for educational use only (The Chief Complaint, 2022). The app serves as a resource to aid in choosing medications, treatments, and care plans, while ultimately leaving decisions to the physician’s discretion.
Clinical Decision-Making
This application can influence the course of care in emergency medicine by breaking down potential scenarios and offering recommendations based on the patient’s condition. Each body system and its corresponding information are easy to reference and are supported by textbooks and research articles, providing the best available information. However, there is a risk of overreliance on the app, making it crucial to use the app as a supplementary resource rather than the sole source of decision-making.
Safety
While The Chief Complaint is intended to reinforce physicians' knowledge, there is a risk that some may rely too heavily on the information provided, potentially overshadowing their clinical judgment. The app’s information could become outdated, with new evidence-based practices not yet incorporated, which could affect patient outcomes. Additionally, the app’s accessibility to non-medical users poses a risk if the information is misinterpreted or used improperly.
Privacy/Security
The application provides a privacy policy stating that it does not collect personal user information such as usernames, emails, credit card numbers, phone numbers, or IDs. However, it does collect analytic data to improve app usability and shares this information with third parties that advertise within the app (The Chief Complaint, 2022). Currently, users cannot share information from the app to social media, though this feature could be beneficial for educational purposes in the future.
User
The app is designed for healthcare professionals, including doctors and advanced practice nurses working in emergency medicine. While it may be used by other specialists, such as hematologists or rheumatologists, the content is primarily focused on emergency care. A medical background is essential to implement the information effectively.
Distribution
The Chief Complaint was created for wide distribution among emergency medicine professionals. The information provided is broad and can be applicable in different countries, although most evidence-based studies referenced are from the USA.
Credibility
The sources of information in the app are credible, coming from medical professionals who studied at prestigious institutions in California. One key source is Emergency Medicine: Reviews and Perspective (EMRAP), which includes videos, guides, eBooks, and podcasts for emergency medicine professionals.
Relevance
While the app includes up-to-date sources, some references are as old as 2007, which could pose a danger if outdated information is used in clinical practice. The most recent update was in June 2023, focusing on bug fixes and minor UI improvements.
Case Study
A 22-year-old female named Marge Simpson presents to the emergency department with lower abdominal pain radiating to the right, along with nausea, vomiting, and a loss of appetite. Dr. Maude Flanders is assigned to the patient. Upon reviewing Marge’s chart, Dr. Flanders notes that Marge is tachycardic, has a fever, and is allergic to shellfish, but has no other known medical history. While Dr. Flanders suspects acute appendicitis, she verifies her diagnosis using The Chief Complaint app. She selects the gastrointestinal tab, navigates to abdominal pain (lower), and confirms the diagnosis with the app’s acute appendicitis section.
Dr. Flanders then discusses her diagnosis with Marge, explaining the plan to get a CT scan, abdominal ultrasound, and repeat blood work, including a CRP level. A consultation with the surgery team is also planned in case the appendix needs removal. After confirming the diagnosis with imaging, Dr. Flanders informs Marge that surgery is necessary to remove the inflamed appendix. She explains that untreated appendicitis could lead to rupture, sepsis, and potentially death, referencing the National Institute of Health (2021) which states, “Appendicitis is the most common cause of acute abdominal pain requiring surgical treatment in persons under 50 years of age.”
Marge consents to the surgery, receives prophylactic antibiotics, and recovers fully. Dr. Flanders continues to use The Chief Complaint app to verify her care plans and consider additional steps for patient treatment.
References
The Chief Complaint. (2022). The Chief Complaint medical references (Version 3.1). [Mobile app]. App Store.
https://apps.apple.com/us/app/the-chief-complaint/id969426649
U.S. Department of Health and Human Services. (2021). Appendicitis - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases.
https://www.niddk.nih.gov/health-information/digestive-diseases/appendicitis
