By: Jessica Otte, MD
STATworkUP, now in its fourth version, is an App designed to help clinicians with the diagnostic thought process and to provide them with evidence-based facts about symptoms and disorders. If you are not a health care professional who does diagnostics, this probably won’t be your thing (and it will be over your head). Self-proclaimed ‘Medical Decision Support computing,’ this software approaches clinical decision-making in a way that mirrors actual practice.
The layout is straightforward but I would not say that the workings of the program are equally as obvious. The bottom menu bar provides the ability to search Symptoms, Studies, Diagnoses, and Treatments.
To start, one can use the menu bar to navigate to Symptoms, select a few symptoms from the list, press ‘Findings’ to review the choices, and the proceed to ‘Differential’ to get the goods. The Symptoms section is the only one in which multiple entries can be selected.
Under Studies, Diagnoses, and Treatments, each entry, once highlighted, will reveal more information about that subject. Then, it can be correlated with a subset of Problems/Disorders/Tests/and Remedies which are alternate names for the Symptoms/Studies/Diagnoses/ and Treatments contents.
What I Liked:
Overall, there is a lot of information below the surface in this program. Contained within the information section of each symptom, lab, or diagnoses there are encyclopedic, point-form descriptions. Also, it is fast. Using the search bar will quickly yield the item you seek. If you want more detailed information, there are integrated web searches, accessed easily with the “info” button which appears with each entry.
Where it really shines, I think, if you are interested in one ‘hallmark’ symptom. There aren’t a lot of references that correlate symptoms to disease so this can be very handy for helping recall that condition that goes with Adie’s pupil or Fetor Hepaticus!
As I found it difficult to get success with my symptom correlations (see below), I think the program is best used in what I might call ‘reverse.’ It’s easiest to view the disorders or lab tests first, read more about their details, and then correlate backwards with the associate symptoms. The treatment section is particularly good in that, unlike a classic drug guide, it provides a more exhaustive list of indications including off-label uses.
What I didn’t like:
Their caveat is true – this really cannot replace a clinician, and of course it isn’t expected to. There may be 10, 000 entries, but some basic things like Dehydration or Hypovolemia are absent (instead there is “mucosal dryness” – not intuitive!). Less common ‘signs’ (like splinter hemorrhages, Janeway lesions, Osler’s nodes, Sister-Mary Joseph’s nodule, etc.) are lacking also.
The lines between symptom/labs/diagnosis are quite blurry. You have to know where to look; there are lots of things that can be both signs/symptoms and diagnoses unto themselves such as hemorrhoids. For these, you just have to look through the different sections until you find them. Obviously a lot of work has gone into making the associations thorough but unless you are in the mind of the designer, you will struggle to chose correlations which yield the expected results.
For example, I often see elderly patients with falls, confusion, and dehydration (“mucosal dryness” in the terms of this App). When I correlate these features, I get a differential which is extensive but still misses the mark. Common things that present this way such as urinary tract infections (UTIs) and hypercalcemia do not appear. Instead “Wallenberg Syndrom” and “vestibular neuronitis” are listed as most likely. Expand the differential and things like “Plague,” “Insulinoma,” and “Shy-Drager Syndrome” appear. Common things are conspicuously absent. Though this isn’t what I expected, the bizarre results are good in that they will challenge you to consider unusual diagnoses and keep a wide view of the differential.
Some entries are obviously not comprehensive. It wasn’t 2 seconds before I had stumbled across entries in the treatment section that had no information about them and had very sparse correlations (despite my knowledge otherwise).
This program probably works a dream in the hands of its creators, but in mine, it’s a bit cumbersome. I do applaud the effort at what I think is the beginning of a great clinical decision making tool, but it’s not quite ‘fleshed out’ enough yet. I can’t help but think of neural networks when looking at this App; in this case, the front end is clean and easy, and the underlying framework is established, but more data must be entered and associations formed before itcan comprehensively perform the task.
Maybe I’m using it incorrectly, or I’ve missed the mark, but I’m what I think is an average user – someone with a bit of programming experience, who regularly uses medical Apps, and who knows about clinical presentations and diagnostics. If it needs a tutorial to walk you through its use, maybe it wasn’t meant for the user-friendly iPhone. I don’t think the claim on the website – that “the operation is intuitive” is fair.
Set your expectations carefully; this isn’t a wizard to replace your clinical reasoning. However, it may help expand your differentials and serve as a reference for a wide range of clinical considerations. There’s lots of room for improvement with future iterations.
Software: STATworkUP version 1.04
Manufacturer: IatroCom (statworkup.com)
Cost: 24.99$ USD Availability: iTunes Store
Basic Connectivity: no subscription or Internet required once installed
Best for: Clinicians who want to broaden their differentials, residents and medical students who need a quick reference for obscure tests
Jessica Otte is a guest writer on iMedicalApps.com, and blogs at Dr. Ottematic