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).
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.
- Simple to use interface that walks providers through a proven algorithm
- App actually has evidence that it promotes correct decision making
- Covers a topic that doesn’t get a lot of attention but can be a life or death issue
- Might be too focused for some users/limited generalizability
- No references or links to other resources
- Not available for Android
CDC PTT Advisor is a helpful tool for providers approaching patients with abnormal coagulation panels. The app has been designed by a multi-site group of nationally-known providers. Most interesting, the app was tested via clinical vignettes on numerous providers at various sites and found to be clinically useful and valid. This is a must-have app for those providers who routinely obtain these labs.
- Overall Score
- User Interface
Easy to use interface that is intuitive and responsive. Includes instructions for use and detailed footnotes for each step.
- Multimedia Usage
App includes a step-by-step algorithm that rapidly advances to the next step and helpful footnotes for each step. The app does not contain links to supporting articles or any PDFs.
App is free.
- Real World Applicability
CDC PTT Advisor puts a proven algorithm to abnormal coagulation testing into the palm of your hand. Although this may not be a daily use app for most primary care providers, those practicing inpatient medicine will certainly find it helpful.
- Device Used For Review
iPhone 8 running iOS 11.3
- Available for DownloadiPhoneiPad