One of my passions is practicing and teaching evidence-based medicine (EBM). Many of the reviews I select to write on iMedicalApps are apps that connect the user to EBM. Our list of the Top Apps of 2017 is filled with EBM apps. But where should providers go for EBM stats? For busy primary care providers and any medical student, resident or even many residency faculties, applying EBM stats at the point of care is just too difficult. You can’t do the math in your head and the calculations going from pre- to post-test probability is mind-boggling. Many of the top medical references such as UpToDate, DynamedPlus, Essential Evidence and Medscape contain great EBM information and some include useful stats such as the number needed to treat (NNT) and number needed to harm (NNH). However, these can be time-consuming to find and depending on your subscription/resource may require an internet/cellular connection. Current medical calculators such as MdCalc, QxCalculate, MediMath, and MedCalc (now MedCalx) include some of these basic EBM stats. So far the most complete EBM calc app is MedCalc 3000 EBM Stats, but it costs $9.99.
Once again, Joshua Steinberg, MD — not an app, but a family physician who develops great apps for primary care — comes to the rescue. In 2017 he was on fire with many new apps including Contraception, Health Maintenance Visit Checklist, and updates to Pneumonia Guide and ABG Eval. Plus, many of his apps are now available for Android.
Over the past 24 months, he has released many apps that I have reviewed here on iMedicalApps, including PneumoVaccines, Depo Calendar, OB Wheels, Gout Diagnosis, Health Maintenance Visits and Step-by-Step Febrile Infant. Other useful point-of-care apps by Dr. Steinberg are PreopEval14, PFT Eval, EFM Guide, PE & DVT Dx Tool, and, my favorite, Pneumonia Guide. This time he turned his attention to EBM stats calculations and created the simple but powerful, EBM Stats Calc. The app does the brain-melting calculations for NNT/NNH/NNS, post-test probability from sensitivity/specificity, and post-test probability from likelihood ratios. Each calculator includes detailed discussion with practical examples. The app is well referenced and very easy to use.
One of the most revered EBM textbooks by Straus, et al. challenges providers to apply EBM stats at the point of care. This involves more than just knowing the NNT/NNH for interventions. Providers are challenged to add the patient expected event rate (PEER) and the cost of preventing an event (COPE) to the NNT/NNH and calculate and use likelihood ratios and properly interpret odds ratios, relative risk, and confidence intervals. Trying to do this at the point of care without a dedicated medical calculator will likely be a non-starter for many providers. Now there is an app that includes these EBM stats and over 50 total EBM stats calculators all in one place called MedCalc 3000 EBM Stats.
Dr. Steinberg’s EBM Stats Calc brings three of the most high-yield EBM calculators to the iPhone. This app will greatly assist residents and faculty in journal clubs with performing cumbersome calculations such as NNT/NNH. Additionally, the inclusion of the pre/post-test probability and likelihood ratio calculators will allow providers to reevaluate their medical decision-making process. The app contains good explanations for each calculator and hyperlinked references. Other options such as MedCalc 3000 EBM Stats and Medicine Toolkit contain significantly more calculators, but cost quite a bit more.
Who would benefit from this EBM app?
Students, nurses, residents, mid-levels, faculty in any specialty, any provider looking to perform EBM stats on their mobile device.
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.
- Simple to use interface with detailed instructions and multiple data input methods
- Includes 3 important EBM calculators plus hyperlinked references to CEBM, The NNT, etc.
- Makes the pre/post-test probability calculations “easy” at the POC
- Only includes 3 calculators
- Could benefit from more examples and suggestions for use
- Not available for Android currently
For students, residents, faculty, and many seasoned providers, the EBM stats in journal articles and discussed at residency journal clubs can be extremely intimidating. EBM Stats Calc brings three of the most commonly discussed calculations (NNT, pre/post-test probability, and likelihood ratios) to your smartphone in an easy-to-use app. There are other options available such as MedCalc 300 EBM Stats, but no other app does what this one does for free. A must-have app for providers who practice/teach evidence-based medicine.
- Overall Score
- User Interface
Like other Dr. Steinberg apps, the design allows for easy data input but nothing fancy.
- Multimedia Usage
App has 3 primary EBM stats calculators and includes references with hyperlinks. Other app store options offer more calculators, but at a price.
App is free.
- Real World Applicability
EBM Stats Calc brings high-yield calculations for making sense of the medical literature to your iPhone. Students, residents, and faculty will find this app valuable for journal clubs. The app challenges providers to think about their medical decision-making process from an EBM stats perspective. However, the post-test probability and likelihood ratio calculators may not be utilized in a busy primary care practice.
- Device Used For Review
iPhone 8 running iOS 11.2.1
- Available for DownloadiPhoneiPad