The Evidence behind the Symptom Checker


The Symptom Checker contains 300 care guides (134 adult; 166 pediatric). The care guides help adults and parents perform accurate self-triage and self-care. The creation of new care guides and the yearly update of existing ones use the following evidence-based resources.


Origin: After-Hours Telephone Triage and Advice Protocols

The Symptom Checker care guides are all derived from the most widely-used telephone care protocols in the world. The Schmitt telephone triage protocols are used in over 400 medical call centers in the United States and Canada (95% of North American market). They have been the preferred decision-support tool in many call centers since 1994. Triage nurses use these protocols to manage over 10 million calls per year. Many physicians and nurses refer to them as the standard of care. The Schmitt protocols are based on the following resources and evidence:


  • National Guidelines and Policies (e.g., AAP, AAFP, ACEP, ACOG, CDC, FDA, AHA, ADA and other national organizations)
  • The medical literature, including Cochrane reviews
  • Expert reviewers (more than 100)
  • Published research studies on the protocols (11)


New Information and Yearly Updates

Every year the after-hours telehealth protocols are updated and the Symptom Checker is a downstream product. When appropriate, similar changes are made in the Symptom Checker content. Updates are based on the following:


  • Changes in the medical literature
  • Requested reviews from national organizations
  • Findings from Quality Improvement projects at 9 medical call centers
  • Findings from reviews of high risk calls.
  • Recommendations from nurse managers and medical directors of call centers
  • Reviews from a PCP Advisory Panel

Symptom checkers based upon the Schmitt nurse triage protocols were more likely to provide appropriate triage decisions than those that did not. Study conducted by Harvard physicians, published August 2015.


American Academy of Pediatrics (AAP) Review and Approval

Since 2010, the AAP has used our Pediatric Symptom Checker on their public parenting website ( They also asked Self Care Decisions to develop the official AAP Symptom Checker Apps: KidsDoc and KidsDoc en Espanol. Prior to implementation, the AAP reviewed the Symptom Checker content and made few recommendations.


Health Literacy Advisor Software

The Care Guides are written at a 6th grade health literacy level. They have been tested by the latest software from Health Literacy Innovations. This means more consumers can understand and follow their guidance. Attention to health literacy is recommended by the NIH, CDC and other national medical organizations.


Mobile App Reviews

The Symptom Checker mobile apps have received many reviews: all of them are positive. The Self Care Decisions’ Symptom Checker guides users as to what action to take regarding their symptoms. It reduces unnecessary ED visits and offloads after-hours calls. It also provides detailed home care advice, making it easy for users to manage minor illnesses and injuries at home.



The Symptom Checker and the nurse triage content from which it was derived are both trusted by doctors and nurses. The Symptom Checker care guides are currently being used by hundreds of healthcare organizations, including 350 office websites and within 30+ mobile phone apps.

Triage Accuracy of Symptom Checker Apps: 5-Year Follow-up Evaluation

Copyright © Malte L Schmieding, Marvin Kopka, Konrad Schmidt, Sven Schulz-Niethammer, Felix Balzer, Markus A Feufel. Originally published in the Journal of Medical Internet Research (, 10.05.2022
Evaluation of symptom checkers for self diagnosis and triage: audit study

BMJ 2015; 351:H3480

Symptom checkers based upon the Schmitt-Thompson nurse triage protocols were more likely to provide appropriate triage decisions than those that did not. Study conducted by Harvard physicians, published August 2015.