1. Introduction

Trauma-related mortality is a significant public health issue [1]. In different settings including developing countries, the health status of many patients, particularly in rural areas, can critically deteriorate before reaching emergency medical services due to longer transfer times; therefore, rapid and accurate first-aid intervention in trauma patients at the scene can be life-saving [2–6].

It has been suggested that some trauma-related deaths could be prevented with basic first-aid procedures for trauma patients [7, 8]. Various studies have demonstrated that early and adequate cardiopulmonary resuscitation (CPR) by lay rescuers in witnessed nontraumatic cardiac arrest cases improving outcomes in prehospital cardiac arrest patients [9, 10]. Rapid and accurate intervention by lay rescuers and healthcare professionals can decrease mortality and morbidity in trauma patients by ensuring safety at the accident scene, maintaining cervical stabilization, ensuring airway patency, performing CPR, controlling external bleeding, and preventing hypothermia [11].

Potential lay rescuers may have insufficient knowledge to respond to urgent health problems that occur in their surroundings, and as a result, they can seek medical information from alternative sources [12]. The Internet has emerged as the primary source for obtaining such information. The World Wide Web provides broad information for patients and their relatives to access health-related information. More than half of patients use the Internet to get medical information [13]. Web-based platforms that facilitate content and information sharing have revolutionized global information sharing [14]. This significant transformation has led to numerous innovations in accessing, disseminating, and conducting information-related educational activities. Even beyond patients and the general population, medical students and healthcare professionals use the Internet and social media to get medical information [15].

YouTube, the largest video search engine on the Internet, is primarily used for sharing videos including social content, and the platform also hosts visual content for educational purposes [16, 17]. Despite the existing challenges, the readily available and expeditious accessibility of the Internet provides a promising potential for playing a crucial role in facilitating individuals’ acquisition of medical knowledge. However, these visual materials can be published directly without undergoing any control mechanism. As a result, individuals may not be aware of the accuracy and reliability of this information, and they might need to grasp the significance of this issue fully [18].

The aim of this study was to investigate the reliability, quality, and information content of ATLS scenarios related to trauma management on YouTube.

2. Materials and Methods

The study was approved by the Ethics Committee of the XXX City Hospital (E-30041352-514.19.99-213995999) and conducted by the guidelines of the Declaration of Helsinki.

This study had a cross-sectional analytical design. English videos uploaded to YouTube from January 1, 2018, to April 1, 2023, containing the keywords “management of trauma” and “assessment of trauma” based on the ATLS (10th edition) publication date, were searched. After applying the exclusion criteria, the remaining videos were reviewed.

The exclusion criteria included nonmedical content (advertisements, news, and interviews), videos in languages other than English, videos containing advertisements, live-action footage lacking educational content, comedy or entertaining content unrelated to educational purposes, videos consisting of interviews or news content, duplicate videos (videos uploaded by different users but containing the same content or shorter versions of the same video), videos not involving trauma scenarios, videos covering nontrauma topics, and videos uploaded before January 1, 2018.

The videos that met the study criteria were evaluated based on the uploader, video length, and view count. All videos included in the study were independently reviewed by two authors (emergency physicians). In cases of disagreement between the two emergency physicians, a third specialist was consulted.

The videos were evaluated using the ATLS (10th edition) guidelines, the modified DISCERN (m-DISCERN), and the Global Quality Scale (GQS) criteria.

Initially, the physicians assessed the videos according to 10 criteria based on the ATLS (10th edition) guidelines and awarded 1 point for each criterion covered by the video (Table 1). A score of eight or higher could be considered a sufficient educational video rating.

The quality and reliability of the videos included in the study data were evaluated using the “GQS” and the “m-DISCERN” scales, utilized in several internet-based studies before [19–22].

The DISCERN scale was designed to assess the quality of written information about treatment options for any health condition used by individuals seeking healthcare services and information providers. The m-DISCERN scale (m-DISCERN) consisting of five questions was utilized to evaluate visual media and visual information. Each question received a score of 1 for “yes” answers and 0 for “no” answers resulting in a scale where the highest score is five and the lowest is 0. This scoring system evaluated the video’s objectivity, reliability, and comprehensibility from the perspective of information sources [23, 24].

The reliability and integrity of the information presented in the content were assessed using the m-DISCERN scale. Each question received a score of 1 for “yes” and 0 for “no” (Table 2).

The GQS is a scoring system developed by Bernard et al. to assess the quality of information obtained from Internet sources. It measures the quality of the video content. The scale ranges from one to five, with five indicating the highest quality, representing videos with clear and comprehensive information, while one shows very low quality, with most information missing [20].

The GQS was used to evaluate the video quality. The scoring ranges from 1 to 5, where 1-2 points indicate low quality, 3 points indicate moderate quality, and 4-5 points indicate high video quality. The scoring definitions are shown in Table 3.

3. Results

Of the 939 videos obtained from the search using specific keywords, 667 were excluded as they did not meet the study criteria. The remaining 272 videos formed the study group (Figure 1) and were watched and evaluated by two independent emergency physicians. In videos that were scored differently by two evaluators, the final decision was made by a third person.

One million two hundred seventy-one thousand eight hundred thirteen views were recorded for the 272 eligible videos in the study. The median number of views or clicks is 125 (with an interquartile range (IQR) of 62–396). The median length of the videos was 419 s (IQR 305–567). The characteristics of the videos included in the study are presented in Table 4.

The videos’ median score was 8 (with an IQR of 7-8) according to the compliance of the ATLS (10th edition) guidelines. The comparison of video scores based on different variables is presented in Table 5. The scores were significantly different between groups (p < 0.001). In binary comparisons, videos uploaded by official institutions and healthcare professionals had higher scores compared to the unclassified group (p = 0.003). There was no significant difference in scores between videos uploaded by official institutions and healthcare professionals (8 [IQR 8-9] and 8 [IQR 7-9], p = 0.963).

The median number of views for videos uploaded by official institutions was 16,109 (with an IQR of 1610-110,291), for healthcare professionals was 238 (with an IQR of 88-3155), and for unclassified sources was 108 (with an IQR of 56–184). In the analysis that assesses the number of views based on the video sources, statistically significant differences were found in all three groups (p < 0.05).

Out of the 76 videos containing misinformation or incorrect practices (GQS = 1 and 2), 60 were uploaded by unidentified individuals, and healthcare professionals uploaded 16 on YouTube. These videos had lower view counts compared to the other videos, and a statistically significant difference was found in view counts when compared to the view counts of other videos (114 [IQR 58-235] and 1286 [IQR 136-11889], p < 0.05).

According to the GQS scale, 86% of the videos were of low or moderate quality. When comparing the sources that uploaded the videos, a statistically significant difference was found (p < 0.05). Only 3.3% of the videos uploaded by unidentified sources were of high quality, while 85.7% of the videos uploaded by official institutions were of high quality. In addition, there were no low-quality videos among those uploaded by official institutions. Unidentified sources uploaded 78% of the low-quality videos. Among the videos uploaded by unidentified sources, only 3% were of high quality.

When examining the scales used to assess the quality of videos, it was found that only five videos provided additional information sources for users according to the m-DISCERN scale, and seven videos addressed controversial or uncertain topics. When comparing the sources that uploaded the videos on YouTube, a significant difference was found in the scores according to the m-DISCERN scale. The average scores of the m-DISCERN scale were significantly higher in videos uploaded by healthcare professionals than those uploaded by unidentified individuals (p < 0.05).

4. Discussion

YouTube is a popular video-sharing platform where uploading and accessing videos is fast, free, and easy. Patients and healthcare professionals use video-sharing sites such as the Internet and YouTube at increasing rates and frequency to obtain information on health-related issues [25]. Although platforms such as YouTube are seen as potential sources of information, it is sometimes difficult to find the content we seek from the right sources. In our study, 71% of the videos did not meet the inclusion criteria. In previous studies involving the reliability of YouTube videos, 80%–94% of the videos were excluded [15, 26–29]. Although this rate has decreased slightly in our study, 3 out of 4 videos still need to show the content we seek. The high exclusion rate makes it difficult to find the necessary content on a video-sharing site such as YouTube, which has reached many views. In addition, this problem is partially solved by developing a particular infrastructure according to the educational platforms of sharing sites such as YouTube and adding the options to determine the content according to the researched subject.

Trauma is one of the leading causes of mortality worldwide. Online platforms have also become a source of information on trauma management. One of the online platforms, YouTube, has the potential to play a significant role in facilitating individuals’ access to information about medical conditions. In this study, we analyzed the content and quality of the information in the trauma management videos on YouTube according to the ATLS (10. Ed) guidelines. Studies on visual scientific content on the Internet are evaluated with scales such as m-DISCERN. The information’s currency, accuracy, and quality are determined by the scores formed after the evaluation. GQS, on the other hand, is a five-point Likert scale based on the quality of information, the flow of information presented online, and ease of use [20–24, 30, 31]. Therefore, GQS and m-DISCERN scales were used in our study. Our study, which we examined according to these two scales and the ATLS (10th edition) guideline, determined that YouTube videos were insufficient in providing consistency and video quality according to current information and guidelines on trauma management. Table 6 presents the key studies that summarize the scientific evidence cited in discussing our results.

In the study of Şahin et al., independent users uploaded the vast majority of videos containing low-quality medical information. It has been determined that the videos uploaded by health professionals to YouTube are of higher quality than those uploaded by independent individuals, and they have received higher scores according to the scales [32]. According to the GQS scale, 86% of the videos examined in our study have low and medium quality. Unknown users uploaded 76% of low- and medium-quality videos. As a result of the rapid introduction of digital applications into our lives, free-of-charge platforms such as YouTube that can reach large audiences have become a source of medical information [33]. Therefore, low-quality videos containing false information uploaded by uncertain individuals endanger public health. To prevent this negative situation, videos with high scores from the GQS and m-DISCERN scales uploaded by health professionals and official institutions should be prioritized and kept in the foreground in YouTube’s software algorithm.

In a study by Sing et al. to characterize the content and quality of information about rheumatoid arthritis on YouTube, it was found that nonprofit and academic videos were the best sources of information. However, these videos only represent 12.7% of the total videos. In addition, it was found that the viewing rate of these videos was only 13.4% [24]. There are also studies showing that most of those who watch health-related videos on the Internet are interested in something other than the source of the video. This also implies that people receive health advice without consistently examining the quality indicators of the information they find online [34]. Considering that unknown users uploaded 67% of the videos examined in our study, health-related guiding and informative videos uploaded by nonexperts in the field should be monitored and restricted by YouTube. Videos of such low quality and misleading content should only be permitted for publication after undergoing thorough review and evaluation.

None of the videos uploaded by official institutions scored below eight according to the ATLS (10th edition) guidelines. In addition, according to the GQS scale, it was determined that the content uploaded by official institutions had no low-quality videos. According to the m-DISCERN scale, videos uploaded by healthcare professionals and unidentified people had the lowest score of 0, although the videos of official institutions did not score below 2 points. This shows that the videos of official institutions are much more qualified, and accurate information can be accessed. However, the videos uploaded by official institutions constitute only 2% of all videos. To change this situation, it is crucial to create more videos adhering to standardization guidelines provided by relevant official institutions. These videos should be informative, concise, easily understandable, unbiased, and address contentious topics while offering essential supplementary resources.

In the survey studies, it was found that 86% of the Internet users accessing health-related information believe that the information they have obtained is reliable, and 64% stated that this information affects the decision they will make about the treatment [35]. The medical information obtained over the Internet is increasing exponentially every day, and it is seen that it affects patients’ decisions. In addition, since there is no control mechanism, this information can be provided to the Internet by many different sources, as seen in our study. This situation leads to questioning the reliability, adequacy, and quality of medical information obtained online [36]. The reliability of medical information is still unknown. In our study, 56% of the videos received a score of 8 or higher according to the ATLS (10th edition) guidelines, yet 86% were rated as low or moderate quality based on the GQS. In addition, only 1.1% of the videos obtained the highest scores of 4-5 points according to the m-DISCERN scale. For this reason, there is a need for up-to-date, reliable, sufficient, and quality videos.

Although the overall image/broadcast quality of YouTube videos is better with the developing technology, there are videos with insufficient content according to our study’s ATLS (10th edition) guidelines. Therefore, scoring on the GQS scale, where video quality and content are evaluated together, caused low scores due to lack of content. Also, in the m-DISCERN scale, not specifying additional information sources for viewers and not questioning ambiguous and controversial issues cause high-quality and very useful videos to receive low scores. The medium-scale videos watched by emergency medicine physicians specializing in trauma do not mean that these videos are insufficient for the public. Videos included in the study are unsuitable for healthcare professionals’ use as they must meet the academic and scientific criteria set by GQS, m-DISCERN, and the latest guidelines. The rationale is that videos scoring 4-5 points according to the m-DISCERN scale constitute only 1.1% of the videos. In popular social media channels such as YouTube, content producers create concise and summarized videos to attract a larger audience. Videos are crafted to be captivating, concise, and aligned with current guidelines due to concern for higher viewership. They avoid controversial subjects and content that redirect viewers to supplementary resources. This causes videos to receive low scores on the m-DISCERN scale.

More than half of Internet users say the information they find influences their decisions about how to treat a disease or condition. On the other hand, 35% of people say that the information they reach affects their decision to see a physician [34]. According to the GQS scale, 86% of the videos examined in our study are of low to medium quality. Unknown individuals uploaded 67.6%, and 27.9% contained false information. Therefore, to increase the online accessibility of accurate medical information, government agencies and health professionals should emphasize that people should be selective when accessing medical information from the web. Government agencies and healthcare professionals should provide basic guidance on content evaluation, such as assessing information based on the Medical Library Association’s user’s guide to finding and evaluating health information on the web [37].

By the literature, the results of our study also showed that the videos uploaded by official institutions and health professionals contain more accurate information [26, 38–40]. The median score of videos uploaded by official institutions and healthcare professionals was found to be 8, while the median score of videos uploaded by unknown individuals was 7. In addition, videos uploaded by official institutions and health professionals were watched 150 times more than videos uploaded by unknown people. This suggested that the videos uploaded by unknown individuals were less watched as they did not inspire confidence.

No significant relationship was found between the number of video views and video scores. Similarly, no relationship was found between the number of video views and video quality in studies conducted on different subjects [38–40]. However, a statistically significant difference was found between the video source and the number of views in all three groups (p < 0.05). While the number of views of official institutions was the highest, the number of views of unknown individuals was the lowest. In addition, the videos uploaded by unknown individuals do not have more than 10,000 views. This indicates that users tend to disregard health advice from unreliable sources and place more trust in content provided by official institutions. Consequently, videos from official institutions are more reliable.

Our study has several limitations. First, our study was limited to a single snapshot analysis of English-only videos on YouTube. Only the videos during the study period were examined. In addition, the fact that other channels and websites that provide health information were not examined can be considered a limitation of our study. In addition, it would be possible to find trauma-related educational videos on various channels using keywords other than the determined ones.

In other studies in the literature, video evaluations were made with criteria such as the first three pages, the first ten pages, or the first 200 videos [22, 24, 41, 42]. This limitation was removed in our study, and all videos from ATLS (10th edition) published from 2018 to the present day were evaluated.

5. Conclusion

Healthcare professionals and individuals should not consider YouTube videos on trauma management as a completely reliable source of information. Official institutions and healthcare professionals should proactively contribute to disseminating reliable information on trauma management and preventing misinformation by publishing updated videos from reliable and scientific sources, based on current guidelines.

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

A.O.K.: conception, analysis and interpretation, and critical review.

B. K.: design, literature review, and critical review.

E.A.A.: fundings, literature review, and data collection and/or processing.

J.S.: design, supervision, and critical review.

L.S.: design, supervision, analysis, and interpretation.

M.E.: design, literature review, and critical review.

M.Y.: conception, materials, analysis, and interpretation.

O.F.T.: fundings, data collection and/or processing, and literature review.

S.G.: conception and materials.

S.H.A.: design, supervision, and critical review.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.