An update to Dr. Steinberg’s PE & DVT dx tool app to include VTE diagnosis in pregnancy.

Many of us in family medicine practice full scope including inpatient medicine and obstetrics. It serves a great need for our patients and is a nice break from clinic to spend a week on inpatient and/or caring for our pregnant patients all the way thru delivery. One of the most common diagnosis in inpatient medicine is venous thromboembolism (VTE). According to the Centers for Disease Control and Prevention (CDC), as many as 900,000 people per year are affected by VTE. Tragically, upwards of 100,000 people die of VTE; 30% die within 1 month of the diagnosis. Due to these sobering statistics, the proper and timely diagnosis of VTE is critical.

There are several accepted clinical decision rules for VTE most commonly used being the Well’s Criteria and the Geneva Score. The original Well’s score for DVT was published in 1997 and Well’s PE score in 2000. Since then countless validation studies have been published including those that incorporated the scores with the d-dimer lab test and radiographic modalities including ultrasound, CT, and VQ scans. When these scores are combined with the above labs/rads, the positive and negative predictive value of the tools increases significantly. This permits providers to “rule-in” and “rule-out” VTE quickly using a point-of-care calculator. The scores can be found on many calculator apps such as MDCalc, QXCalculate, but few combine all of the calculators including Geneva in one app with all of the supporting literature. For more than 10 years, I have been using Dr. Joshua Steinberg’s original DVT/PE app for Palm, then Windows, and most recently iOS. He has just updated this app to now include VTE diagnosis in pregnancy using the Geneva score in addition to the classic Well’s scores for DVT/PE.

 

Here at iMedicalApps, we are fans of Dr. Steinberg’s high-yield, easy-to-use, and always free apps. Over the past 2.5 years, he has released many apps that I have reviewed here on iMedicalApps including Preconception Care, Contraception, EBM Stats Calc, PneumoVaccines, Depo Calendar, OB Wheels, Gout Diagnosis, Health Maintenance Visits, and Step-by-Step Febrile Infant. Other useful point-of-care apps by D.r Steinberg include PreopEval14, PFT Eval, EFM Guide, and, my favorite Pneumonia Guide.

 

Clinical Scenario:

You are seeing a 22-year-old G1P1 at 30 weeks gestation who presents to labor and delivery with unilateral leg swelling and shortness of breath. She denies recent surgery, active cancer, or prior VTE. Her vitals are within normal limits except an HR of 100. On exam, she is tender on the posterior left thigh and the left leg is visibly more swollen than the right leg. You suspect possible VTE. How would you go about making this diagnosis?

Evidence-based medicine

The app contains information from the most widely accepted publications on the work-up of VTE including the original Well’s studies, the Christopher Investigator studies, review articles on the topic, and a recently published study on the work-up of VTE in pregnancy. The app cleverly assembles this data into easy to follow algorithms using the Well’s criteria for DVT and PE, Geneva score for VTE in pregnancy, and various modalities including d-dimer, lower extremity ultrasounds, CT, and even VQ scanning. The app is a one-stop shop for VTE diagnosis.

What providers would benefit from this App?

Students, residents, nurses, mid-levels, family medicine, internal medicine, emergency medicine/urgent care and any provider who works-up patients with possible VTE.

 

Price

  • Free

Likes

  • Evidence-based algorithms now updated with the latest studies
  •  Question-based format for navigating many sections of the app with auto-screen switching
  • Covers multiple scenarios and multiple diagnostic testing modalities

Dislikes

  • App doesn’t perform any “math”/calculations for the user
  • Pictures of algorithms do not pinch/zoom/landscape
  • Not available for Android

Overall

An outstanding update to one of Dr. Steinberg’s original apps. PE/DVT Dx now includes the ability to work-up DVT/PE in pregnancy using data from a recently published study. He also has made some more minor changes to the interface, added more references, and some under the hood improvements. The app is still basic in that you have to do “your own math” on the Well’s and Geneva scores but otherwise is very user-friendly. It is indispensable for providers who work-up VTE patients.

 

Overall Score

  • 4.5 stars

User Interface

  • 4.5 stars

Easy-to-use interface with step-by-step questions and automatically switching screens. The only problem is that the calculations must be done by hand with no built in calculators.

Multimedia Usage

  •  4.0 stars

App contains detailed reference section and pictures of each algorithm for each distinctive scenario. Pictures would be easier to view if one could pinch/zoom and/or landscape view.

 

Price

  •  5 stars

The app is free!

Real World Applicability

  • 4.5 stars

An app that covers the gamut of patients presenting with possible VTE (PE/DVT) now including pregnant patients. The app is easy to use at the point of care and includes all of the applicable references and easy to follow algorithms — highly recommended.

Device Used For Review

  • iPhone 8 running iOS 12.1.1

Available for iPhone and iPad. Not available for Android at this time.

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.