Few medical conditions create more anxiety for parents and providers than a sick infant or child. Two of the top reasons for parents to bring their children to the ER or an urgent care center are fever and asthma. According to the CDC, one in 13 people in the United States has asthma, and fever is one of the top five reasons for children to be brought to the ER. Over the last 20 years, several guidelines have been published using low-risk criteria including the Rochester and Philadelphia Criteria to help providers decide which febrile infants are at highest risk of invasive bacterial illness. More recently, Drs. Gomez, Mintegi, et al. published their step-by-step method of determining risk of invasive bacterial infection in the febrile infant. We favorably reviewed the Step-By-Step app from Dr. Joshua Steinberg. There are numerous apps for asthma available, but none include the new guideline developed between the American Academy of Pediatrics and Children’s Mercy Hospital in Kansas City. Their previous app, iGuideline, was one of my favorites but was never updated for the 64-bit iOS requirements. Now the app is back in a new look and new content this time focused on asthma and the febrile infant. More guidelines are projected to be added to the app as they are released.
PedsGuide from Children’s Mercy Hospital contains two evidence-based guidelines developed with the American Academy of Pediatrics (AAP) on pediatric asthma and the febrile infant. The asthma guideline is called PIPA: Pathways for Improving Pediatric Asthma and the Febrile Infant guideline is called REVISE: Reducing Excessive Variability in Infant Sepsis Evaluation. Both are part of the AAP’s Value in Inpatient Medicine (VIP) project. The app does not provide the full guidelines or links to them. The asthma guideline includes validated scoring systems such as the Respiratory Score and CARET scores. It is unclear if the febrile infant algorithm has been validated or how it compares to the recently published Step-by-Step Febrile Infant published in 2016 in Pediatrics. Regardless, the app expertly translates the guidelines into an easy to use interface that can be used at the point-of-care.
What providers would benefit from this App?
Students, residents, mid-levels, family medicine, pediatric, emergency medicine, and any provider who cares for children with asthma and/or febrile infants.
o Well designed algorithms for asthma and febrile infant.
o Quality videos on MDI use in the asthma section.
o Available for Android.
o Only two guidelines at this time (resuscitation guideline coming).
o The CARAT asthma risk assessment website works poorly on mobile devices.
o No links to guidelines or references.
Although the original (and excellent) iGuideline from Children’s Mercy Hospital is no longer available, this new PedsGuide serves as version 3.0. This new version currently only contains two guidelines–asthma and febrile infant; although, a 3rd guideline on resuscitation is “coming soon.” The app guidelines were developed in conjunction with the AAP and could be viewed as a gold standard of sorts. However, numerous other evidence-based guidelines for these two common diagnostic dilemmas exist, but this app is a good place to start.
Easy to navigate with minimal screens; easy to go back/restart algorithm.
o 4.0 stars
Highly useful videos on proper MDI use, but no links to guidelines or references.
o 5 stars
App is free!
Real World Applicability
o 4.5 stars
PedsGuide from Children’s Mercy Hospital and the AAP provides to highly useful guidelines for pediatric asthma and the febrile infant. The app is easy to use and would be worth a download for anyone who treats children in acute/urgent care, emergency rooms, or inpatient settings. The app would be even better if it include links to the full guidelines and references. An alternative for the febrile infant guideline is the excellent Dr Steinberg app, Step-by-Step Febrile Infant. I have not found a similar dedicated asthma app utilizing the AAP PIPA asthma pathway.
Device Used For Review
o iPhone 8 running iOS 12.3
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.