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The Quality of Pediatric Orthopaedic Information on the Internet

Winship, Brenton BA*; Grisell, Margaret MD, MBA; Yang, Carolyn B. MD; Chen, Rachel X. MS§; Bauer, Andrea S. MD*

Journal of Pediatric Orthopaedics: June 2014 - Volume 34 - Issue 4 - p 474–477
doi: 10.1097/BPO.0000000000000125
Selected Topics

Background: Many patients use the Internet for health information. However, there are few guarantees to the reliability and accuracy of this information. This study examined the quality and content of the Internet Web pages for 10 common pediatric orthopaedic diagnoses.

Methods: We identified 10 common diagnoses in pediatric orthopaedics: brachial plexus injury, cerebral palsy, clubfoot, developmental dysplasia of the hip, leg length discrepancy, osteochondroma, polydactyly, scoliosis, spina bifida, and syndactyly. We used 2 of the most popular search engines to identify the top 10 Web sites for each disease. We evaluated the Web sites utilizing both the quality-based Health On the Net (HON) Foundation criteria and our own content-based grading sheets. The custom grading sheets focused on essential information about disease summary, pathogenesis, diagnosis, treatment, and prognosis.

Results: Three orthopaedic surgeons graded 98 academic, commercial, nonprofit, and physicians’ Web sites for 10 diseases. Academic Web sites scored the highest in content (mean, 60.8%±15.5%), whereas commercial Web sites scored the lowest (mean, 46.7%±22.2%). Among the diagnoses, osteochondroma Web sites had the highest content scores (mean, 75.8%±11.8%), whereas polydactyly Web sites had the lowest content scores (mean, 39.3%±15.7%). In contrast, Web sites about developmental dysplasia of the hip had the highest HON scores (65.0±11.1), whereas those about brachial plexus birth palsy scored the lowest (42.6%±16.9%). Among the content subgroups, scores were generally higher for disease summary and diagnostics and lower for prognosis.

Conclusions: The Internet Web sites reviewed demonstrated a wide range of content and information. We found that nonprofit and academic Web sites were the most reliable sources, whereas commercial and, surprisingly, physician-run Web sites were the least reliable. We advise physicians to talk to their patients about the information they get on the Internet and how it dictates their expectations. We hope this study, combined with further understanding of how our patients use this information, can help improve the Internet content.

Clinical Relevance: Physicians should know that their patients may be receiving misleading information from the Internet and be able to discuss this with their patients.

*Department of Orthopaedic Surgery, Shriners Hospital for Children Northern California, Sacramento

§Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Davis, CA

Department of Orthopaedic Surgery, St Louis University, St Louis, MO

Department of Orthopaedic Surgery, Kaiser Permanente, Salem, OR

Supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through grant #UL1 TR000002.

The authors declare no conflicts of interest.

Reprints: Andrea S. Bauer, MD, Department of Orthopaedic Surgery, Shriners Hospital for Children Northern California, 2425 Stockton Blvd, Sacramento, CA 95817. E-mail:

© 2014 by Lippincott Williams & Wilkins