Online Patient Education Materials for Pediatric Septic Arthritis Exceed Recommended Reading Levels: A Readability Analysis

TL;DR

This study finds that online patient education materials about pediatric septic arthritis are too hard to read, often exceeding the recommended sixth-grade level.

Contribution

The study evaluates readability of PEMs on pediatric septic arthritis from top US hospitals and identifies a significant gap in accessibility.

Findings

The mean readability level of PEMs was grade 10.6, exceeding the recommended sixth-grade level.

Only 41.7% of PEMs were at or below the eighth-grade reading level, mostly from identical third-party content.

Higher-ranked hospitals did not significantly correlate with better readability scores.

Abstract

Background: Pediatric septic arthritis is a time-sensitive orthopedic emergency requiring prompt recognition and treatment to avoid serious morbidity. Families often seek information online, yet prior studies show patient education materials (PEMs) in orthopedics frequently exceed recommended readability standards (≤6th-grade level).

Purpose: This study aims to evaluate the readability of online PEMs on pediatric septic arthritis from top-ranked US pediatric orthopedic hospitals and assess alignment with readability guidelines.

Methods: In July 2025, websites of the top 25 US pediatric orthopedic hospitals were searched for PEMs on “septic arthritis” in children. Hospitals were included if they hosted a dedicated PEM ≥100 words. Text was extracted, cleaned of non-narrative elements, and analyzed with eight readability metrics: Flesch-Kincaid Grade Level (FKGL), Gunning Fog Index, Simple Measure of Gobbledygook (SMOG), Coleman-Liau Index, Automated Readability Index (ARI), Flesch Reading Ease Score (FRES), Ford, Caylor, Sticht (FORCAST) formula, and Dale-Chall Readability Score. Descriptive statistics were summarized, and FKGL was correlated with hospital rank using Spearman’s test.

Results: Of 25 hospitals, 12 (48%) hosted qualifying PEMs. The mean readability was grade 10.6, above the recommended sixth-grade level; none achieved ≤6. Seven institutional PEMs were written at an average reading level significantly above the eighth-grade reading level (p < 0.01). Five PEMs (41.7%) were written at or below the eighth-grade level, largely from identical third-party content. Mean FRES was 51, reflecting “somewhat challenging” readability. Higher-ranked hospitals trended toward worse FKGL scores, but correlation was nonsignificant (ρ = -0.32; p = 0.31).

Conclusions: Nearly half of the top hospitals lacked PEMs on pediatric septic arthritis, and available content largely exceeded recommended readability. Adoption of plain-language guidelines, external audits, or artificial intelligence (AI)-assisted editing may enhance accessibility and equity.

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