Chronic wound care: A systematized review of Internet resources available to patients

To the Editor: Currently, chronic wounds affect 6.5 million Americans and cost upward of 25 billion US dollars in treatment annually. As chronic wounds increasingly threaten the health of patients and society at large, it is imperative that comprehensive information resources be available to patients. In recent years, the Internet has emerged as a significant source of information for patients and practitioners alike. Census reports suggest that 85% of all US adults use the Internet and 72% of users have looked up health information on the Web in the past year. While the Internet may abound with information of variable quality and veracity, overall, it has allowed for greater public access to educational materials. As chronic wounds confer significant comorbidities and burden to patients, we sought to obtain greater understanding of the availability of web-based resources for patients. The aim of this letter is meant to evaluate the quality of Internet resources available to patients with chronic wounds, using a validated scoring instrument. Web-sites concerned with chronic wounds were analyzed in a systematic fashion. Our Internet searches were designed to mimic those frequently performed by the general public. As eight out of 10 online health searches are done through general search engines, we utilized Google as it is the preferred search engine by over 80% of Americans. Thus, we entered the following five search terms into Google: chronic wounds, leg ulcer, foot ulcer, diabetic ulcer, and pressure ulcer (Figure 1A). We limited analyses of web-sites to the first 20 results for each search term as studies have shown that individuals tend not to consider results beyond the second page. Web-sites were excluded if they were inaccessible or if they represented a duplicate result of a web-site we had already analyzed. A total of 78 unique web-sites were considered in our analysis. Web-sites were classified by authorship according to four major subtypes: medical or specialty organizations, academic (produced by a peer-reviewed journal), government (US or international), or commercial (for-profit initiatives). Of the web-sites examined, 25 web-sites were created by medical or specialty organizations, four were academic, 11 were from government institutions, and 38 were produced by commercial enterprises. Each of the 78 unique web-sites for chronic wounds was assessed using the DISCERN instrument, a validated tool created to judge the quality of written consumer health information. The DISCERN instrument consists of 16 questions and a total score range of 15–80, with higher scores associated with higher quality written information (excellent = 63–80; good = 51–62; fair = 39–50; poor = 27–38; very poor = 15– 26). The first and second authors examined and scored each web-site independently according to the 16 individual DISCERN items detailed in Figure 1B, using the official DISCERN Handbook for guidance. The mean DISCERN score for the 78 unique web-sites scored by both authors was 40.7 (standard deviation [SD], 11.54; range, 19–63.5), which falls under the quality category of “fair. ” Overall, one author rated the web-sites as “poor” with a total mean DISCERN score of 33.6, whereas the other author rated the articles as “fair” with a total mean DISCERN score of 47.82. The scores of the two authors often varied, which may be attributable to a difference in interpretation of the DISCERN items. The two highest DISCERN scores of 63.5 and 62.5 were assigned to chronic wound care guidelines issued by the American Society of Plastic Surgeons and the Wound Healing Society, respectively. The DISCERN scoring process revealed almost all web-sites to be deficient in information concerning how treatment choices affect overall quality of life, and none provided support for the shared decision-making process.