title: Variability of patient spine education by Internet search engine.
abstract: BACKGROUND
  Patients are increasingly reliant upon the Internet as a primary source of medical information. The educational experience varies by search engine, search term, and changes daily. There are no tools for critical evaluation of spinal surgery websites.
  
  
  OBJECTIVE
  To highlight the variability between common search engines for the same search terms. To detect bias, by prevalence of specific kinds of websites for certain spinal disorders. Demonstrate a simple scoring system of spinal disorder website for patient use, to maximize the quality of information exposed to the patient.
  
  
  METHODS
  Ten common search terms were used to query three of the most common search engines. The top fifty results of each query were tabulated. A negative binomial regression was performed to highlight the variation across each search engine.
  
  
  RESULTS
  Google was more likely than Bing and Yahoo search engines to return hospital ads (P=0.002) and more likely to return scholarly sites of peer-reviewed lite (P=0.003). Educational web sites, surgical group sites, and online web communities had a significantly higher likelihood of returning on any search, regardless of search engine, or search string (P=0.007). Likewise, professional websites, including hospital run, industry sponsored, legal, and peer-reviewed web pages were less likely to be found on a search overall, regardless of engine and search string (P=0.078).
  
  
  CONCLUSIONS
  The Internet is a rapidly growing body of medical information which can serve as a useful tool for patient education. High quality information is readily available, provided that the patient uses a consistent, focused metric for evaluating online spine surgery information, as there is a clear variability in the way search engines present information to the patient.
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd Floor, Philadelphia, USA. Electronic address: georgeghobrial@gmail.com.
authors: George M
authors: GM
authors: Ghobrial
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd Floor, Philadelphia, USA.
authors: Angud
authors: A
authors: Mehdi
authors: Rothman Institute, Department of Orthopedic Surgery, USA.
authors: Mitchell
authors: M
authors: Maltenfort
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd Floor, Philadelphia, USA.
authors: Ashwini D
authors: AD
authors: Sharan
authors: Department of Neurological Surgery, Thomas Jefferson University Hospital, 909 Walnut Street, 3rd Floor, Philadelphia, USA. Electronic address: James.harrop@jefferson.edu.
authors: James S
authors: JS
authors: Harrop
mesh_terms: D054626:Consumer Health Information; D006801:Humans; D020407:Internet; D010353:Patient Education as Topic / Q000379:methods*; D057386:Search Engine; D013122:Spinal Diseases / Q000628:therapy
keywords: Cauda equina; Patient education; Scoliosis; Search engine; Spondylolisthesis