What Information are Patients Receiving from the Internet about the Operative and Non-Operative Management of Acute Appendicitis?

By: Zarrukh Baig, Dr. Mike Moser, & Luke Conlon

Objective: To determine if patients are likely to find the information online that they need to make an informed decision between operative and non-operative management of appendicitis.

Introduction: Operative appendectomy (OA) has remained the gold standard in the treatment of acute appendicitis for the past century. Recent studies suggest that non-operative management with antibiotics (NOMA) may be a reasonable option for managing uncomplicated acute appendicitis. We examined the information currently available online to determine if patients are likely to find the information they need to make an informed decision between the two options.

Methods: An exhaustive list of 29 search terms were established by a focus group and then entered into Google resulting in 49 unique webpages. Each webpage was reviewed by three reviewers and consensus was obtained for bias (OA, NOMA, or balanced), webpage type, JAMA score, reading grade, and DISCERN score.

Results: 30/49 websites (61%) favored surgery, while 13/49 (27%) favored NOMA, and 7/49 (14%) provided balanced information. 12/49 websites (24%) had no information about NOMA at all. 11/12 (92%) patient-directed and 7/9 (78%) physician-directed webpages favored surgery whereas academic webpages presented a more balanced picture. Only 8/49 (16%) sites mentioned that the presence of a fecalith predicts the failure of NOMA. Only 2/49 webpages had reading grades at or below the recommended grade 8 level for patient information. The mean DISCERN score was 48.5 out of 80 (“fair”) with academic webpages having the highest DISCERN score (60).

Conclusion: Most of the webpages available on the internet do not provide sufficient information, nor are they understandable to most patients to make an informed decision about the current options for the management of acute appendicitis.

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