ORIGINAL ARTICLE

Assessing the Quality and Reliability of Patient Information

Regarding First-Aid for Acute Burns on YouTube

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David Parizh, DO , Maleeh Effendi, MD, Elizabeth Dale, MD and Julia Slater, MD

Given ever increasing ease of access to technology, the majority of adults first turn to the internet for medical
advice. The world wide web is filled with user-generated content within multiple social media platforms that lack a
governing body to validate the information’s accuracy and reliability. The authors performed a qualitative review of
first-aid burn resources available on YouTube using two validated scales: Modified Discern and Global Quality Scale.
A search was conducted using the term “burn treatment” on September 18, 2019. Of 120 reviewed videos, 59 met
their inclusion criteria. 36% (n = 21) of the speakers had formal medical training, with only 12% (n = 7) identified
as burn care professionals. The mean views originating from nonmedical speakers (162,675) were more than eight
times that originating from burn centers (14,975). The quality of the videos was compared by video source, speaker,
and specialty. Burn centers had the highest Modified Discern and Global Quality Scale scores, 2.91 and 2.86,
respectively (P < .05). Additionally, the authors were able to demonstrate that there was a statistically significant
higher quality of videos when the speaker was a burn care professional or had formal medical training. Unfortunately,
their review demonstrated that videos originating from hospital systems and burn centers made up a minority of the
online media content. These results illustrate an opportunity for improvement by way of increased content creation
to bolster the online presence of the burn community and provide patients with more accurate information.

Since Tim Berners-Lee invented the World Wide Web in
1990, the internet has become integrated into our daily lives.1
As of January 2020, there are 2.45 billion active Facebook
(Facebook, Inc., Menlo Park, CA) users and 2 billion active
YouTube (Google, LLC, San Bruno, CA) users.2–4 These
platforms have reshaped traditional communication and mul-
timedia with a shift to large-scale user-generated content
across multiple social media platforms. Users are freely able to
post original content without a governing body to validate the
quality and accuracy of information. YouTube is a free video
sharing platform that was started in 2005 and features a wide
variety of user-generated content ranging from music and
game videos, to educational clips making it a leading online
destination for millions of users around the world. It is owned
by Google, whose worldwide market share amongst the
leading search engines was almost 88% in October 2019.2–4
The increased availability of user-generated content has
profound implications in healthcare delivery as 70% of adults
first turn to the internet to seek out medical information.5,6 In
response to this, social media use by medical professionals has
increased in an attempt to advance specialties and improve the
quality of patient care delivered. Websites, social media pages,
and online videos are posted for public viewing by providers
from nearly all medical specialties.
Most burn injuries are not severe enough to require admis-
sion to a burn unit. Between the years 2011 and 2015, 91%
From the Department of Surgery, Division of Plastic, Reconstructive, Hand and
Burn Surgery, University of Cincinnati Medical Center, Ohio
Address correspondence to David Parizh, DO, University of Cincinnati Medical
Center, 231 Albert Sabin Way, OH 45267-0558. Email: parizhdd@ucmail.uc.edu
© The Author(s) 2020. Published by Oxford University Press on behalf of the
American Burn Association. All rights reserved. For permissions, please e-mail:
journals.permissions@oup.com.
doi:10.1093/jbcr/iraa135
of fire or burn injury patients treated in the emergency de-
partment were discharged with outpatient follow-up.7 Given
the high numbers of known outpatient burns, we predict that
there are even more unknown patients with small, nonlife
threatening burns that are treating their injuries at home
using only internet resources. In an attempt to assess if the
burn community was keeping up with virtual patient needs,
we conducted a qualitative review of first-aid burn resources
available to patients on YouTube. Our hypothesis was that the
quality of videos would be higher if the speaker was a burn
care provider.
METHODS
YouTube is a free video sharing platform that was started in
2005 and features a wide variety of user-generated content
ranging from music and game videos, to educational clips
making it a leading online destination for millions of users
around the world. It is owned by Google, whose worldwide
market share amongst the leading search engines was almost
88% in October 2019.2–4 For these reasons, we chose to ex-
plore this video sharing platform. Using Keywords Everywhere,
a browser add-on for Google Chrome, we crosschecked var-
ious phrases and words that patients may use in their search
for information on how to treat a burn. “Burn treatment”
was found to be the most commonly searched phrase. This
was verified using another product called Google Trends that
allowed us to validate an arbitrary search phrase using publicly
available statistical data.
An incognito search on YouTube was conducted on
September 18, 2019. A digital snapshot of the links was stored
so that the content would not be altered while being reviewed.
A total of 120 videos or the first six pages of search content
was analyzed. We excluded any duplicates, videos with news

1
 Journal of Burn Care & Research
2  Parizh, Effendi, Dale, and Slater XXXX/XXXX 2020

Table 1. Modified Discern tool description

Modified Discern

1. Were aims clear and achieved?

2. Were the sources of information reliable?
3. Is the information balanced and unbiased?
4. Are additional resources to learning provided?
5. Does the video address areas of controversy/uncertainty?

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Total of five questions, a point is allocated for each question answered, yes.

or promotional content, and videos that were not in English.

The total view count, training level, specialty of speaker,
and source of medical information (ie, hospital system, burn
center, or other) were recorded.
The entire set of videos were reviewed independently by
two different physician reviewers (D.P. and M.E.) and scored
using two validated scales—Modified Discern (MD) and
Global Quality Scale (GQS).8–10 The MD and GQS are both Figure 1. Video production source breakdown.
graded on a five-point scale for reliability and quality (Tables 1
and 2). A score of 1 would be least reliable, and a score of 5
would be considered most reliable. The reviewers were Plastic
Surgery Residents, with one of them having formal Burn
Fellowship training. In the event that there was more than
one likert point discrepancy between the two reviewers, the
video would be reviewed by a third reviewer (J.S.) who is a
Burn Surgeon.
Descriptive statistics were computed using a combination
of Microsoft Excel (Spokane, WA) and Stata SE 13.0 (College
Station, TX). Comparison between groups using Student’s
T-test and ANOVA were performed with a P-value threshold
of .05. Inter-rater reliability assessment to determine scoring
consistency among raters was performed using Cohen’s κ.
Furthermore, absolute agreement between raters was calcu-
lated using the recorded GQS and MD scores.

RESULTS Figure 2. Training level of speaker in video breakdown.

Of the 120 videos reviewed, 59 met our inclusion criteria and
were analyzed. The majority (n = 39, 66%) of the videos were
generated by users outside of the hospital setting (Figure 1).
The speaker in the video was considered to have formal med-
ical training if they were an advanced care provider or a phy-
sician. Only 36% (n = 21) of the speakers had any formal
medical training (Figure 2). Additionally, only 12% (n = 7)
of the speakers were identified as being burn surgeons, 3%
(n = 2) were trauma/emergency medicine providers, and the
remainder were grouped together under the category of other
(Figure 3).
The mean view count of videos originating from burn
centers was 14,975. Hospital systems had the greatest mean
views at 162,675. Taking into account the higher prevalence
of videos from nonmedical sources and performing a weighted
average of the view counts, we find that the mean number
of views per video are as follows: burn center (365), hospital
system (35,267), and other (99,701) (Table 3).
The mean MD and GQS were determined for each
video and compared by video source, speaker, and specialty
(Figures 4–6). Burn centers had the highest MD and GQS
scores, 2.91 and 2.86, respectively (P < .05), when compared
Table 2. Global Quality Scale tool description
Global Quality Scale
1. Poor quality, very unlikely to be of any use to patients
2. Poor quality but some information present, of very limited use
to patients
3. Suboptimal flow, some information covered but important
topics missing, somewhat useful to patients
4. Good Quality and flow, most important topics covered and
useful to patients
5. Excellent quality and flow, highly useful to patients
Scored on a scale from 1 to 5, based on the above criteria.
with other sources. The quality of the videos was higher if the
speaker had formal medical training, MD of 2.43 and GQS
of 2.6 (P < .05). Burn surgeons had the highest MD (2.93)
and GQS (2.86) scores compared with Trauma/Emergency
Medicine providers and other speakers (P < .05).
Inter-rater reliability analysis using Cohen’s κ revealed κ
values of 0.41 and 0.47 for GQS and MD scoring, respec-
tively. Both of these values were found to be statistically
Journal of Burn Care & Research
Volume XX, Number XX Parizh, Effendi, Dale, and Slater  3

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Figure 5. Mean GQS/MD vs Speaker.
Figure 3. Breakdown of physician specialty of speakers in video.

Table 3. Total number of views vs video source depicted as

a mean and weighted mean
Total Number of Views vs Video Source

Mean Weighted Mean

Burn center 14,975 365

Hospital system 162,675 35,267
Other 131,393 99,701

Figure 6. Mean GQS/MD vs Specialty of Physician.

in burn care delivery, including the Emergency Medicine and

Figure 4. Mean GQS/MD vs Video Source.
significant (P < .05). These values of κ represent a “moderate
amount” of agreement between raters. Furthermore, absolute
agreement between raters was found to be 58% and 63% for
GQS and MD scores, with expected agreement values of 28%
and 30%, respectively.
DISCUSSION
The foundation for burn care delivery is in a multidisciplinary
approach incorporating the expertise of the acute care burn
surgeon, advanced care provider, nursing, nutrition, rehabili-
tation, and social work teams. As such, there are many experts
first responder teams, all capable of providing comprehensive
patient education through online social media platforms. Our
focus was assessing specifically the social media presence of
the inpatient treating team, as well as the overall quality of the
videos present.
We arbitrarily defined a speaker with formal medical
training as one with a minimum of an advanced care provider
degree. The quality of the videos was higher if the speaker had
formal medical training (Figure 5). Burn and ED physicians
represent a minority of the speakers in the videos reviewed
with the remainder of the speakers placed in the category of
other (Figure 3). The grouping of advanced care providers
into this “other” category inflates the quality of videos.
This is likely why in Figure 6, the Trauma/ED physicians
had the lowest quality videos present. Unfortunately, videos
generated from individuals outside of the hospital setting had
a mean view count that was more than eight times that of
burn centers. The true MD and GQS of the majority video
content generated by nonmedical users is even lower than we
demonstrated. The video content created by nonburn care
professionals had a tendency to be misleading and inaccu-
rate. It is our opinion that the content would lead to a delay
of appropriate treatment possibly resulting in infection and

4  Parizh, Effendi, Dale, and Slater
increased need for admission. Occasionally the content was
directly harmful to the patients by instructing them to apply
ice directly to their acute burn wounds, risking further tissue
injury at the burn site.
Through our review of video content on YouTube spe-
cific to burn first-aid, we found that burn care professionals
were underrepresented on overall view counts despite having
higher quality videos. The majority of the videos available to
the public were generated by speakers who were nonburn care
professionals. That is, of the 59 videos reviewed with a total of
6.7 million views, only 164,000 (2.4%) views were generated
by burn centers.
There are 72 burn centers located within the United
States that are registered with the America Burn Association.
We conducted a search of online resources available to
our patients through their respective websites, and found
that only 26 (36%) had any digital resources available.
Additionally, only 5 (6.9%) had specific video resources avail-
able on their websites.
Moving forward, there are multiple opportunities for im-
provement including an entire field of search engine optimi-
zation. The first being content creation, which is something
that we as a community of burn care providers can easily con-
trol. Creation of comprehensive educational videos that entail
basic wound care needs, warning signs, and a direct line of
communication to a community burn center in our opinion
would optimize health care delivery and resource usage.
Additionally, there is an opportunity to extend video content
to incorporate discharge instructions and informed consent.
Secondly, we can increase online foot traffic to our websites
by meeting search engine gold standards. This would increase
your search ranking and includes but not limited to: posting
often and being current; optimizing keywords; improving the
overall “health” of our website infrastructure by decreasing
links that are nonfunctional; and optimizing our website for
mobile viewing. The implementation of these changes can
be tracked through monitoring of quality metrics such as
admissions, clinic visits, length of stay, Press Ganey scores,
and surveys of staff. Additionally, we can engage the viewer
directly through embedded surveys within the video to judge
real-time the utility and quality of our content.
There are limitations to this study including the fact that we
only examined the YouTube platform. There are many social
media platforms that gain popularity over time; however, we
chose to use YouTube due to its ease of accessibility and prom-
inence. The term “burn treatment” is arbitrary; however, we
Journal of Burn Care & Research
XXXX/XXXX 2020
attempted to validate it as the most popular search term with
publicly available search metrics. The video review tools, such
as MD and GQS, can be perceived as subjective; however, they
have been validated and employed for use in similar studies as
noted. Lastly, we are not able to identify demographics spe-
cific to our viewers as these data are not readily available to us.
As we continue to become more efficient with our re-
sources, it is prudent that we take this opportunity and reflect
how we can grow with the digital times in all aspects of patient
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care. Investing in patient education empowers us as experts in
our field, combating the misinformation created by nonburn
care providers. It not only allows us to provide higher quality
care, but also promotes the value of our specialty. The power
of content creation, branding, and marketing are being
realized across multiple specialties. As the saying goes, “If a
tree falls in a forest and no one is around to hear it, does it
make a sound?” If we are providing high quality care for our
patients, shouldn’t they see and know about it? Establishing
a social media presence gives us a platform for education and
a virtual voice to the public; it allows our sound to be heard
in the forest.
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