CDC PTT Advisor Review: An App with Evidence to Support Its Utility

Some of the more common tests ordered, particularly on inpatients, are basic coagulation studies such as the PT, INR, and PTT. These tests are frequently monitored in patients on anticoagulation medication and are part of the standard evaluation of patients with anemia, bleeding issues, and liver abnormalities. Although a number of apps already exist to assist providers in selecting and monitoring anticoagulation, such as the outstanding American College of Cardiology’s Anticoag Evaluator, there are few that assist providers with abnormal coags.

The CDC comes to the rescue with the easy-to-use app called CDC PTT Advisor. Generally, we have been fans of the CDC’s apps. They have released an easy to use Vaccine Schedule app, an excellent STD app, Influenza app, GBS app and Mobile Health app. We have also favorably reviewed their opioid and travel medicine apps.

Using several diagnostic algorithms for both children and adults, the app walks providers through the workup of an abnormal PTT. The app was developed by a group of pathologists from Vanderbilt, University of Alabama, and Cedars-Sinai Hospital. Interestingly, a separate group of physicians attempted to test the accuracy of the app in aiding physician decision making. Most apps have no such evidence, but the CDC PTT Advisor now does. The study was published online ahead of print in the Journal of the American Medical Informatics Association. The authors created eight clinical vignettes with normal and abnormal PTT’s and tested 46 internal medicine physicians at seven different clinical sites. The authors analyzed data from 368 vignettes comparing physician performance using the app to standard clinical decision support. In the vignettes where the CDC PTT Advisor app was used, physicians significantly outperformed standard clinical decision support in correct test ordering and diagnostic decision making (83% vs 70% correct), physician confidence in their decisions (7.5 vs. 6.3 on a 10 point scale), and time to vignette completion (3:02 vs 3:53 minutes).

Evidence-based medicine

Developed by a group of physicians working for the CDC from a proven algorithm for the workup of abnormal coags, the CDC PTT Advisor guides provider decision making. Additionally, the app was studied via multi-site trial using case vignettes in which the app improved proper diagnostic test selection, diagnostic accuracy, physician confidence, and time to correct diagnostic decision.

Who would benefit from this App?

Nurses, students, residents, mid-levels, primary care providers, emergency medicine, internal medicine, and hospitalist providers.

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.