Perform critical appraisal of medical literature using an app, review of CASP

Information Mastery is a concept coined by evidence based medicine (EBM) experts in the US, Canada and the UK. In the US, Information Mastery was championed by Slawson and Shaughnessy who described the vast medical literature as a “jungle” and used the metaphors of “foraging” and “hunting” to navigate that environment. If you wanted to find an answer to a specific question, you needed a “hunting” tool such as UpToDate, Dynamed or Essential Evidence Plus. If you wanted to just wander thru the jungle and see what was new you would use a “foraging” tool such as the DailyPOEM, Prescriber’s Letter or Journal Watch. In short, hunting tools help you answer clinical questions at the point of care and foraging tools alert you to new information.

Over the years, one of the other tenets of Information Mastery has become a bit of a lost art–critical appraisal. How does one take a journal off their desk, select an article to read and determine its validity–its trustworthiness? The Straus book, “Evidence Based Medicine: How to Practice and Teach It” certainly can be used for this process, but it can be time consuming. This book has become the primary textbook for evidence based medicine over the years, but doesn’t provide a true mobile app of the tools provided in the book (their website still lists Palm and Pocket PC calculators). The Critical Appraisal Skills Programme (CASP) was developed in Oxford, UK in 1993 and uses specific methods to develop the skills of critical appraisal in health care professionals. Over the years many different worksheets have been developed to appraise articles from cohort to RCT to systematic reviews. In our program alone we have used the JAMA worksheets, a variation of our own of the JAMA worksheets, the Straus textbook worksheets, and most recently those of the CASP. We have found the CASP to be the most user friendly to the beginners in critical appraisal especially medical students and residents. When I saw that CASP had released an app that contained their worksheets and other EBM tools, I had to check it out.

The app is simple in its layout. When you open the app, the default view is the list of appraisals that you have completed. Unlike the outstanding Journal Club app or others like it, CASP leaves the work to you, but provides you expert tools for the job. The app prompts you to create a title for your journal article review, add the PubMed ID or link and select the appropriate CASP worksheet (eight different study design options are included). The app also has an outstanding A-Z EBM glossary and a section called Calculators that, unfortunately, only includes a number needed to treat (NNT) and pretest probability calculator.

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Evidence based medicine

CASP is the quintessential EBM app. The app will make any healthcare provider a better consumer of the medical literature. Certainly most of us will still prefer the hunting and foraging tools that we now have at our disposal in the internet age, but when you must read/review an article from start to finish this is the app to use. The EBM glossary and calculators are a nice addition.

What providers would benefit from this App?
Students, residents, mid-levels, any staff provider who reads and reviews the medical literature.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.