Review of Red Book app by Academy of Pediatrics for infectious disease

Introduction:

The American Academy of Pediatrics’ Red Book Online app is a mobile version of the AAP’s definitive antimicrobial guide. It provides detailed and authoritative information on common and obscure infectious diseases that affect children. It is in an easily searchable format that helps in the formation of point-of-care decisions for general pediatricians and general practitioners.

The Red Book includes details of infectious diseases from actinomycosis to Yersenia enteritis including information on clinical manifestations, treatment and control measures, immunizations including immunizations of special populations, recommended pediatric doses, and prophylactics. The amount of information in the app and its replacement of a nearly 1058 page tome, makes it a supremely useful tool for clinicians. However, the app can be frustrating to use, limiting its functionality in everyday practice.

User Interface:

The app opens to a home page where users can search or go directly to contents, images, resources, tables, news, favorites, updates or disease lookup.

Search is somewhat limited by the Red Book’s layout, which does not permit searching by symptoms or conditions. Searching for “cellulitis,” for example, brings up a menu of choices that include the most common bacteria to cause cellulitis but not a topic devoted to skin and soft tissue infections. Pressing “staphylococcal infections” brings users to the “clinical manifestations” tab where “cellulitis” is highlighted.

In the contents section, the Red Book contains the AAP’s recommendations on a number of areas as diverse as infection control in healthcare settings, medical evaluation of internationally adopted children, as well as diseases transmitted by animals. This can be accessed by pressing the contents button. A menu bar on the bottom of the screen enables easy jumping between sections. Sections of particular interest can be bookmarked and accessed through the favorites tab on the homepage; an improvement would be to include a favorites icon in the bottom navigation bar. The app also contains information on immunizations, especially useful for special situations (e.g. live vaccines for household contacts of immunocompromised children).

The app provides information on “clinical manifestations,” “etiology,” “epidemiology,” “diagnostic tests,” “treatment,” “isolation of the hospitalized patient” and “control measures” for each infectious agent. Users can jump to each section by pressing the hyperlink. Clinical manifestations include details on presenting symptomatology, etiology lists details on the organism and epidemiology includes details on areas and seasons when the disease is more prevalent.

The diagnostic tests section lays out recommended testing but does not include sensitivity/specificity or predictive value data. The treatment section includes duration of treatment and either tabular details on recommended dosages/antimicrobials or hyperlinks to tables of recommendations. Although there is data on weight adjusted dosages, there is no built in calculator, requiring the use of another application to determine the actual dose for each patient. Integrating a calculator function into dosages would add to the app’s utility at the point-of-care.

The user interface is text heavy. There are hyperlinks to images that include rashes, clinical findings, radiographs, path specimens and gram stains. Other than taking a screenshot, however, there is no way to copy the images or open them in any other apps. Furthermore, although there are hyperlinks in the pathogen section, the other sections of the app require a lot of scrolling.

The user interface has a couple of other unfortunate quirks. Going from “favorites” to other content requires going back to the homepage, even if what’s favorited is a subsection of a broader topic. There is a section for “updates” and “news” that includes frequent updates that are never integrated into the app — for example, updated influenza guidelines require going to the “news” section, then clicking on a link that opens a web-page in the in-app browser. More frequent app updates integrating new data, similar to the Micromedex app, would be a useful addition.

The “resources” tab brings very scant resources — just more information on vaccines and a link to influenza resources. There is also a button to “earn CME” which includes a broken hyperlink. The vaccine page is simply the CDC’s 2013 recommended and catch-up immunization charts without the ability to personalize for patients or even a link to the CDC’s excellent web-based vaccine catch-up scheduler.

Evidence to support app use:

• The AAP’s Committee on Infectious Diseases (COID) develops and revises the guidelines included in the Red Book. The Committee includes general pediatricians, pediatric infectious disease specialists, and a number of collaborators from organizations such as the CDC. The app generally does not reference specific studies or evidence but is a summary of COID’s recommendations.

Healthcare providers that would benefit from the app:

• General practitioners, general pediatricians