MISSION Syncope: For the busy primary care provider, the evaluation and management of patients with syncope can be challenging and fraud with conflicting recommendations and opinions on the work-up and management.
Both the American College of Cardiology and the American College of Neurology have evidence/expert-based guidelines for the condition with somewhat different approaches. And there are several evidence-based clinical decision rules for syncope including the Canadian Syncope Risk Score (CSRS), the San Francisco Syncope Rule, and the EGSYS and OESIL Scores. These rules are available in various medical calculator apps such as QxCalculate, MediMath, MedCalc, and our favorite, MDCalc.
Now the University of Kentucky has produced an app called MISSION Syncope that expands upon the popular CSRS by combining the medical literature, expert guidelines, and the results of the CSRS to create an “evidence-based differential diagnosis”. The app asks twenty questions to generate a list of most common to least common causes of syncope including cardiogenic, vasovagal, orthostatic, and neurogenic.
MISSION Syncope then asks the user to select which they believe the patient most likely has and provides the recommended workup for that type of syncope. Additionally, the app still provides the results of the CSRS to ensure patients at high risk of syncope morbidity/mortality are properly observed/admitted/worked-up. The app does not provide any references or links to its questions, recommendations. Details on the CSRS can be found in PubMed or in apps such as MDCalc.
Evidence-Based Medicine
MISSION Syncope contains some of the most famous Ottawa Rules with links to all of the original validation studies for each. Additionally, the app contains high-quality videos showing the author applying each rule at the bedside on simulated patients. Surprisingly the app doesn’t contain information on the sensitivity/specificity/likelihood ratios for each rule unless you pull up the linked articles. Apps such as MDCalc contain much of the same information as well as hundreds of additional calculators.
Who would benefit from this App?
Students, nurses, residents, mid-levels, emergency medicine, primary care providers who evaluate and treat patients with syncope.
Price
o Free.
Likes
o Simple to use interface with easy to follow questions to guide the work-up
o Provides a recommended differential diagnosis with additional work-up recommendations in addition to the CSRS
o Available for Android.
Dislikes
o App lacks any information about the authors or links to references
o Does not contain additional details about the differential diagnosis or management of syncope
o No ability to just calculate the CSRS without answering all twenty questions
Overall
This app should assist providers who frequently encounter patients with syncope. The app will help ensure the proper differential diagnoses are generated and those with high CSRS are properly evaluated. The app could be improved with more details about the differential diagnosis and recommended evaluation and treatment of syncope.
Overall Score
o 4.5 stars
User Interface
o 4.5 stars
Easy to follow interface with brisk response/advancement through the app’s twenty questions to arrive at the differential diagnosis, etc.
Multimedia Usage
o 4.0 stars
The app deftly leads users through twenty questions about syncope to provide reasonable differentials, CSRS results, and suggested work-up. The app lacks any outside links or references or information about the authors.
Price
o 5 stars
App is free.
Real-World Applicability
o 4 stars
The MISSION Syncope app expands upon the Canadian Syncope Risk Score assisting providers with their differential diagnosis and suggested work-up in addition to providing the CSRS results. The app is free and available for both iOS and Android. The app could be improved with more details about the differential, work-up, and references for the results. It would also be nice to just be able to calculate the CSRS within the app; otherwise, some providers will likely just stick with their favorite risk calculator app such as MDCalc or QXCalculate.
Device Used For Review
o iPhone 11Pro running iOS 13.3.1
Available for Download for iPhone, iPad, and Android.
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.
