The Quality and Content of Health Information in Internet Websites for Patients on Chest Pain Symptoms

Objective: Chest pain is a common symptom where causes range from benign to serious. We assess quality and content of websites for patients about chest pain that describe causes and when to seek care. Methods: We used five search engines (Google, Bing, Yahoo, Ask, AOL) and searched for “chest pain”. For included websites, we assessed specific content potentially useful to patients with chest pain, information quality using DISCERN, HONcode and JAMA benchmark criteria, readability using four validated scores, and LIDA for accessibility, usability and reliability. Results: In 27 included websites, 96% and 81% mentioned cardiac and non-cardiac causes of chest pain, respectively, while 85% described when to seek emergency care. Only 51% of websites mentioned potential tests used to diagnose symptoms, 22% described potential treatments, and 11% mentioned consequences if treatment is delayed or avoided. Average DISCERN ratings were 20 ± 7 / 45 points (low to medium quality). 44% of websites had HONcode certification, and 11% fulfilled all JAMA benchmark criteria. Average Flesch-Kincaid Reading Ease score was 59, which is (fairly difficult to read). With LIDA, the average scores were “medium” for accessibility 83% and usability 59%, and “low” for reliability 43%. Conclusion: Internet websites intended to help patients understand and triage symptoms of chest pain contain highly variable information content, and are on average of low to medium quality and difficult to read. This is concerning given that the Internet is a primary source of health information and that chest pain is a common, potentially life-threatening symptom