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. 2025 May 1;33(9):e502-e510.
doi: 10.5435/JAAOS-D-24-00617. Epub 2024 Dec 18.

Readability of Online Pediatric Orthopaedic Trauma Patient Education Materials

Diane Ghanem  1 , John Avendano, Elizabeth Wang, Gabrielle Reichard, Aoife MacMahon, Aaron Brandt, Babar Shafiq
Affiliations

Readability of Online Pediatric Orthopaedic Trauma Patient Education Materials

Diane Ghanem et al. J Am Acad Orthop Surg. .

Abstract

Introduction: The importance of web resources for educating orthopaedic trauma patients is well recognized. Yet these resources often exceed the sixth-grade reading level and are too complex for most patients to understand. This study examines the readability of the American Academy of Orthopaedic Surgeons' (AAOS) pediatric trauma-related educational content compared with similar materials from the Pediatric Orthopaedic Society of North America (POSNA).

Methods: Eleven AAOS ( https://www.orthoinfo.org/ ) and nine POSNA ( https://orthokids.org ) pediatric trauma education articles were included. Articles' readability was assessed by two independent examiners using (1) the Flesch-Kincaid Grade Level (FKGL) and the Flesch Reading Ease (FRE) algorithms. The FKGL mean was compared with the sixth-grade level and the average American reading level using a one-sample t -test. A two-sample t -test evaluated the differences in readability between the AAOS and POSNA materials.

Results: A total of 15 unique articles were included. Excellent agreement (>90%) was noted between reviewers for FKGL and FRE. The average (SD) FKGL for AAOS and POSNA articles were 8.5 (0.8) and 9.0 (1.5), respectively, and the FRE scores were 61.2 (3.8) for AAOS and 61.7 (7.7) for POSNA. Only one AAOS article met the sixth-grade reading level. The average readability levels of the AAOS and POSNA articles were markedly higher than the recommended sixth-grade level ( P < 0.001). No notable difference was found in FKGL ( P = 0.47) or FRE ( P = 0.89) when comparing AAOS and POSNA articles.

Discussion: This study indicates that the readability of the AAOS pediatric trauma and POSNA trauma-related articles is well above that which is recommended for the general public, and this has remained so for more than a decade. Both POSNA and AAOS trauma education materials have high readability levels, potentially hindering patient understanding. Improving the readability of these widely used trauma education resources is overdue and will likely improve patient comprehension.

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