Top-cited articles in emergency medicine

Original Contribution

Top-cited articles in emergency medicine

Yi-Lun Tsai MDa, Chien-Chang Lee MD, MSca,b,*, Shyr-Chyr Chen MDa,

Zui-Shen Yen MD, MPHa

aDepartment of Emergency Medicine, National Taiwan University Hospital, Taipei 100, Taiwan

bGraduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei 100, Taiwan

Received 29 August 2005; revised 1 January 2006; accepted 2 January 2006


Study Objective: Our purpose was to identify and examine the characteristics of the most frequently cited articles in the field of emergency medicine (EM).

Methods: Top-cited EM articles in 9 EM journals were identified by searching the computerized database of the Science Citation Index Expanded and the Web of Science (1972 to present). Median citation numbers, authors’ nationalities, publication year, and fields of study were described and discussed. Mann-Whitney U and Kruskal-Wallis tests were used to compare groups.

Results: All top-cited articles were published during 1972 and 2002. We identified 100 top-cited articles published in 6 EM journals, led by Annals of Emergency Medicine (66) and American Journal of Emergency Medicine (22). Toxicology, traumatology, resuscitation medicine, and cardiovascular medicine were the primary focus of study. The median citation number for these top-cited articles was 102 (range, 71-335).

Conclusion: Our analysis gives an encyclopedic review of citation frequency of top-cited articles published in EM journals, which may provide information for those who want to find the history, evolution, and areas of high-impact research activities of EM.

D 2006


Governments, funding agencies and promotion commit- tees, and academic institutions are increasingly interested in measuring the research quality and productivity of individual scientists as an indication of their scholarly excellence. Citation rating using data from the Institute for

* Corresponding author. Department of Emergency Medicine, National Taiwan University Hospital, Taipei 100, Taiwan. Tel.: +886 2 2356 2168;

fax: +886 2 2322 3150.

E-mail address: [email protected] (C.-C. Lee).

Scientific Information (ISI), owned by the Thomson Corporation of Toronto, is now a popular method to evaluate the impact on the scientific community of individual scientists and research institutions. The argu- ment is that the greater the value of the article, the more times it will be cited, and that the citation number is thus viewed as a direct measure of the recognition that this publication has had in its scientific field [1]. Although there is obviously considerable debate regarding the value of citation rates [2,3], the analysis of citation rates may give an encyclopedic review of citation frequency and key areas of scientific interest. Emergency medicine (EM) has

0735-6757/$ – see front matter D 2006 doi:10.1016/j.ajem.2006.01.001

Table 1

Top 100 most frequently cited articles in EM journals ranked in order of citations received



Times cited


Eisenberg MS, Hardwood BT, Cummins RO, et al. Cardiac arrest and resuscitation–a tale of 29 cities. Ann


Emerg Med 1990;19:179-86


Becker LB, Ostrander MP, Barrett J, et al. American Heart Association. Outcome of CPR in a large


metropolitan area–where are the survivors. Ann Emerg Med 1991;20:335-61


Gibler WB, Runyon JP, Levy RC, et al. A rapid diagnostic and treatment center for patients with chest pain


in the emergency department. Ann Emerg Med 1995;25:1-8


Cummins RO. American Heart Association. Recommended guidelines for uniform reporting of data from


out-of-hospital cardiac arrest–the Utstein style. Ann Emerg Med 1991;20:861-74


Tatum JL, Jesse RL, Kontos MC, et al. Comprehensive strategy for the evaluation and triage of the chest


pain patient. Ann Emerg Med 1997;29:116-25


Larsen MP, Eisenberg MS, Cummins RO, et al. Predicting survival from out-of-hospital cardiac arrest–a


graphic model. Ann Emerg Med 1993;22:1652-8


Mccarthy BD, Beshansky JR, Dagostino RB, et al. missed diagnoses of acute myocardial infarction in the


emergency department–resuscitation from a multicenter study. Ann Emerg Med 1993;22:579-82


Cales RH. Trauma mortality in Orange county–the effect of implementation of a regional Trauma system.


Ann Emerg Med 1984;13:1-10


Rutherford WH, Merrett JD, Mcdonald JR. Symptoms at one year following concussion from minor head


injuries. Injury 1979;10:225-30


Cummins RO, Eisenberg MS, Hallstrom AP, et al. Survival of out-of-hospital cardiac arrest with early


initiation of cardiopulmonary resuscitation. Am J Emerg Med 1985;3:114-9


Ho MT, Eisenberg MS, Litwin PE, et al. Delay between onset of chest pain and seeking medical care–the


effect of public education Ann Emerg Med 1989;18:723-31


Ralston SH, Voorhees WD, Babbs CF. Intrapulmonary epinephrine during prolonged cardiopulmonary


resuscitation–improved regional blood flow and resuscitation in dogs. Ann Emerg Med 1984;13:79-86


Litovitz TL, Smilkstein M, Felberg L, et al. 1996 annual report of the American Association of Poison


Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1997;15:447-500


Litovitz TL, Felberg L, White S, et al. 1995 annual report of the American Association of Poison Control


Centers Toxic Exposure Surveillance System. Am J Emerg Med 1996;14:487-537


Todd KH, Funk KG, Funk JP, et al. Clinical significance of reported changes in Pain severity. Ann Emerg


Med 1996;27:485-9


Litovitz TL, Klein-Schwartz W, Dyer KS, et al. 1997 Annual report of the American Association of Poison


Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1998;16:443-97


Gibler WB, Young GP, Hedges, et al. Acute myocardial infarction in chest pain patients with nondiagnostic


ECGs–serial CK-MB sampling in the emergency department. Ann Emerg Med 1992;21:504-12


Maningas PA, Deguzman LR, Tillman FJ, et al. Small-volume infusion of 7.5 percent NaCl in 6 percent


Dextran-70 for treatment of severe hemorrhagic shock in swine. Ann Emerg Med 1986;15:1131-7


Litovitz TL, Klein-Schwartz W, Caravati EM, et al. 1998 annual report of the American Association of


Poison control centers Toxic Exposure Surveillance System. Am J Emerg Med 1999;17:435-87


Weaver WD, Cobb LA, Hallstrom AP, et al. Considerations for improving survival from out-of-hospital


cardiac arrest. Ann Emerg Med 1986;15:1181-6


Kulig K, Baror D, Cantrill SV, et al. Rockey Mountain Poison Center. Management of acutely poisoned


patients without gastric emptying. Ann Emerg Med 1985;14:562-7


Litovitz TL, Felberg L, Soloway RA, et al. 1994 annual report of the American Association of Poison


Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1995;13:551-97


Rusnak RA, Stair TO, Hansen K, et al. Litigation against the emergency physician–common features in


cases of missed myocardial infarction. Ann Emerg Med 1989;18:1029-34


Martin GJ, Adams SL, Martin HG, et al. Prospective evaluation of syncope. Ann Emerg Med 1984;13:




Stern SA, Dronen SC, Birrer P, et al. Effect of blood pressure on hemorrhage volume and survival in a near-


fatal hemorrhage model incorporating a Vascular injury. Ann Emerg Med 1993;22:155-63


Christoph RA, Buchanan L, Begalla K, et al. pain reduction in local anesthetic administration through pH


buffering. Ann Emerg Med 1988;17:117-20


Gibler WB, Lewis LM, Erb RE, et al. Early detection of acute myocardial infarction in patients presenting


with chest pain and nondiagnostic ECGs: serial CK-MB sampling in the emergency department. Ann Emerg

Med 1990;19:1359-66

Table 1 (continued)

Rank Citation Times cited

  1. Stiell IG, Greenberg GH, McKnight RD, et al. A study to develop clinical decision rules for the use of radiography in acute ankle injuries. Ann Emerg Med 1992;21:384-9
  2. Litovitz TL, Holm KC, Clancy C, et al. 1992 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1993;11:494-555
  3. Litovitz TL, Schmitz BF, Matyunas N, et al. 1987 annual report of the American Association of Poison Control Centers National Data Collection System. Am J Emerg Med 1988;6:479-515
  4. White RD, Asplin BR, Bugliosi TF, et al. High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and paramedics. Ann Emerg Med 1996;28:480-5
  5. Roth R, Stewart RD, Rogers K, et al. Out-of-hospital cardiac arrest: factors associated with survival. Ann Emerg Med 1984;13:237-43
  6. Litovitz TL, Klein-Schwartz W, White S, et al. 1999 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2000;18:517-74
  7. Mcleer SV, Anwar RAH, Herman S, et al. Education is not enough–a system failure in protecting battered woman. Ann Emerg Med 1989;18:651-3
  8. Litovitz TL, Clark LR, Soloway RA. 1993 annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 1994;12:546-84
  9. Litovitz TL, Klein-Schwartz W, White S, et al. 2000 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2001;19:337-95










  1. Siesjo BK. Basic mechanisms of traumatic brain damage. Ann Emerg Med 1993;22:959-69 99
  2. Debard ML. Cardiopulmonary resuscitation–analysis of 6 years experience and review of the literature. 98

Ann Emerg Med 1981;10:408-16

  1. Van Hoeyweghen RJ, Bossaert LL, Mullie A, et al. Quality and efficiency of bystander CPR. Belgian 96

Cerebral Resuscitation Study Group. Resuscitation 1993;26:47-52

  1. Rowe BH, Keller JL, Oxman AD, et al. Effectiveness of Steroid therapy in acute exacerbations of asthma: a 96

meta-analysis. Am J Emerg Med 1992;10:301-10

  1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 1986;15:557-64 95
  2. Niemann JT, Criley JM, Rosborough JP, et al. Predictive indices of successful Cardiac resuscitation after 95

prolonged arrest and experimental cardiopulmonary resuscitation. Ann Emerg Med 1985;14:521-8

  1. Green SM, Johnson NE. ketamine sedation for pediatric procedures: Part 2, Review and implications. Ann 95

Emerg Med 1990;19:1033-46

  1. Ludwig S, Warman M. shaken baby syndrome: a review of 20 cases. Ann Emerg Med 1984;13:104-7 94
  2. Deans GT, Magalliard JN, Kerr M, et al. Neck sprain–a major cause of disability following car accidents. 93

Injury 1987;18:10-2

  1. Litovitz TL, Schmitz BF, Holm KC. 1988 annual report of the American Association of Poison Control 93

Centers National Data Collection System. Am J Emerg Med 1989;7:495-545

  1. Litovitz TL, Schmitz BF, Bailey KM. 1989 annual report of the American Association of Poison Control 92

Centers National Data Collection System. Am J Emerg Med 1990;8:394-442

  1. Young W. Secondary injury mechanisms in acute spinal cord injury. J Emerg Med 1993;11 Suppl 1:13-22 92
  2. Eisenberg M, Bergner L, Hallstrom A. Epidemiology of cardiac arrest and resuscitation in children. Ann 90

Emerg Med 1983;12:672-4

  1. Gay GR. Clinical management of acute and chronic cocaine poisoning. Ann Emerg Med 1982;11:562-72 90
  2. Gormican SP. CRAMS scale: field triage of Trauma victims. Ann Emerg Med 1982;11:132-5 90
  3. National Heart Attack Alert Program Coordinating Committee. Emergency department: rapid identification 90

and treatment of patients with acute myocardial infarction. National Heart Attack Alert Program Coordinating Committee, 60 Minutes to Treatment Working Group. Ann Emerg Med 1994;23:311-29

  1. White BC, Gadzinski DS, Hoehner PJ, et al. Effect of flunarizine on canine cerebral cortical blood flow and 89

vascular resistance post cardiac arrest. Ann Emerg Med 1982;11:119-26

  1. Anderson DK, Hall ED. Pathophysiology of spinal cord trauma. Ann Emerg Med 1993;22:987-992 89
  2. Oestern HJ, Tscherne J, Sturm J, et al. Classification of the severity of injury. Unfallchirurg 1985;88: 88


  1. Robertson C, Steen P, Adgey J, et al. The 1998 European Resuscitation Council guidelines for adult 88

advanced life support: a statement from the Working Group on Advanced Life Support, and approved by the executive committee. Resuscitation 1998;37:81-90

  1. Thom SR, Taber RL, Mendiguren II, et al. Delayed neuropsychologic sequelae after carbon monoxide 8 7

poisoning: prevention by treatment with Hyperbaric oxygen. Ann Emerg Med 1995;25:474-80

(continued on next page)

Table 1 (continued)

Rank Citation Times cited

  1. Todd KH, Deaton C, D’Adamo AP, et al. Ethnicity and analgesic practice. Ann Emerg Med 2000;35:11-6 87
  2. Hoffman JR, Schriger DL, Mower W, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: 86

a prospective study. Ann Emerg Med 1992;21:1454-60

  1. Maimaris C, Barnes MR, Allen MJ. bWhiplash injuriesQ of the neck: a retrospective study. Injury 1988;19: 85


  1. Okumura T, Takasu N, Ishimatsu S, et al. Report on 640 victims of the Tokyo subway sarin attack. Ann 85

Emerg Med 1996;28:129-35

  1. Rosetti VA, Thompson BM, Miller J, et al. Intraosseous infusion: an alternative route of pediatric 84

intravascular access. Ann Emerg Med 1985;14:885-8

  1. Litovitz TL, Normann SA, Veltri JC. 1985 Annual Report of the American Association of Poison Control 83

Centers National Data Collection System. Am J Emerg Med 1986;4:427-58

  1. Litovitz TL, Martin TG, Schmitz B. 1986 annual report of the American Association of Poison Control 83

Centers National Data Collection System. Am J Emerg Med 1987;5:405-45

  1. Lamke LO, Liljedahl SO. Plasma volume changes after infusion of various plasma expanders. 83

Resuscitation 1976;5:93-102

  1. Litovitz TL, Bailey KM, Schmitz BF, et al. 1990 annual report of the American Association of Poison 82

Control Centers National Data Collection System. Am J Emerg Med 1991;9:461-509

  1. Litwin PE, Eisenberg MS, Hallstrom AP, et al. The location of collapse and its effect on survival from 82

cardiac arrest. Ann Emerg Med 1987;16:787-91

  1. Wrightson P, Gronwall D. Time off work and symptoms after Minor head injury. Injury 1981;12:445-54 82
  2. Baraff LJ, Bass JW, Fleisher GR, et al. Practice guideline for the management of infants and children 0 to 81

36 months of age with fever without source. Agency for Health Care Policy and Research. Ann Emerg Med


  1. Callaham M, Kassel D. Epidemiology of fatal tricyclic antidepressant ingestion: implications for 81

management. Ann Emerg Med 1985;14:1-9

  1. Gibb KA, Yee AS, Johnston CC, et al. Accuracy and usefulness of a breath alcohol analyzer. Ann Emerg 81

Med 1984;13:516-20

  1. Litovitz TL, Holm KC, Bailey KM, et al. 1991 annual report of the American Association of Poison 80

Control Centers National Data Collection System. Am J Emerg Med 1992;10:452-505

  1. Litovitz TL, Klein-Schwartz W, Rodgers GC Jr, et al. 2001 Annual report of the American Association of 79

Poison Control Centers Toxic Exposure Surveillance System. Am J Emerg Med 2002;20:391-452

  1. Bickell WH, Bruttig SP, Millnamow GA, et al. Use of hypertonic saline/dextran versus lactated Ringer‘s 79

solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine. Ann Emerg Med 1992;21:1077-85

  1. Derlet RW, Richards JR. Overcrowding in the nation’s emergency departments: complex causes and 79

disturbing effects. Ann Emerg Med 2000;35:63-8

  1. Gibler WB, Gibler CD, Weinshenker E, et al. Myoglobin as an early indicator of acute myocardial 79

infarction. Ann Emerg Med 1987;16:851-6

  1. Quinn JV, Drzewiecki A, Li MM, et al. A randomized, controlled trial comparing a tissue adhesive with 79

suturing in the repair of pediatric facial lacerations. Ann Emerg Med 1993;22:1130-5

  1. Safar P, Abramson NS, Angelos M, et al. International Resuscitation Research Center. Emergency 78

cardiopulmonary bypass for resuscitation from prolonged cardiac arrest. Am J Emerg Med 1990;8:55-67

  1. Curry S. Methemoglobinemia. Ann Emerg Med 1982;11:214-21 78
  2. Povlishock JT. Pathobiology of traumatically induced Axonal injury in animals and man. Ann Emerg Med 78


  1. Tafuri J, Roberts J. organophosphate poisoning. Ann Emerg Med 1987;16:193-202 78
  2. Sedgwick ML, Dalziel K, Watson J, et al. Performance of an established system of first responder out-of- 78

hospital defibrillation. The results of the second year of the Heartstart Scotland Project in the dUtstein StyleT. Resuscitation 1993;26:75-88

  1. Myers RA, Snyder SK, Emhoff TA. Subacute sequelae of carbon monoxide poisoning. Ann Emerg Med 78


  1. Hunt TK. The physiology of wound healing. Ann Emerg Med 1988;17:1265-73 77
  2. Danzl DF, Pozos RS, Auerbach PS, et al. Multicenter hypothermia survey. Ann Emerg Med 1987;16: 76


Table 1 (continued)

Rank Citation Times cited

  1. Nowak RM, Pensler MI, Sarkar DD, et al. Comparison of peak expiratory flow and FEV1 admission 76

criteria for acute bronchial asthma. Ann Emerg Med 1982;11:64-9

  1. Sakles JC, Laurin EG, Rantapaa AA, et al. Airway management in the emergency department: a one-year 76

study of 610 tracheal intubations. Ann Emerg Med 1998;31:325-32

  1. Selker HP, Zalenski RJ, Antman EM, et al. An evaluation of technologies for identifying acute cardiac 76

ischemia in the emergency department: a report from a National Heart Attack Alert Program Working Group. Ann Emerg Med 1997;29:13-87

  1. Babbs CF. Role of iron ions in the genesis of reperfusion injury following successful cardiopulmonary 75

resuscitation: preliminary data and a biochemical hypothesis. Ann Emerg Med 1985;14:777-83

  1. Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. Am J Emerg Med 1989;7:620-3 75
  2. Hughes AN, Jordan BA. Mechanical properties of surgical bone screws and some aspects of insertion 75

practice. Injury 1972;4:25-38.

  1. Green SM, Nakamura R, Johnson NE. Ketamine sedation for pediatric procedures: Part 1, A prospective 73

series. Ann Emerg Med 1990;19:1024-32

  1. Plummer D, Brunette D, Asinger R, et al. Emergency department echocardiography improves outcome in 73

Penetrating cardiac injury. Ann Emerg Med 1992;21:709-12

  1. Sacchetti A, Schafermeyer R, Geradi M, et al. American College of Emergency Medicine. Pediatric 73

analgesia and sedation. Ann Emerg Med 1994;23:237-50

  1. Norkool DM, Kirkpatrick JN. Treatment of acute carbon monoxide poisoning with hyperbaric oxygen: a 73

review of 115 cases. Ann Emerg Med 1985;14:1168-71

  1. Dyer JE. Gamma-hydroxybutyrate–a health food product producing coma and seizurelike activity. Am J 73

Emerg Med 1991;9:321-4

  1. White RD, Hankins DG, Bugliosi TF. Seven years’ experience with Early defibrillation by police and 72

paramedics in an emergency medical services system. Resuscitation 1998;39:145-51

  1. Bernstein E, Diskant BM. Phenylpropanolamine–a potentially hazardous drug. Ann Emerg Med 71


  1. Chin RL, Sporer KA, Cullison B, et al. Clinical course of gamma-hydroxybutyrate overdose. Ann Emerg 71

Med 1998;31:716-22

  1. Kellermann AL, Staves DR, Hackman BB. In-hospital resuscitation following unsuccessful prehospital 71

advanced cardiac life support–heroic efforts or an exercise in futility. Ann Emerg Med 1988;17:589-94

undergone substantial developments in the past few decades and is now evolving at a rapid pace. However, a systemic analysis of top-cited articles in the field of EM is not yet available.

The aim of the present study was to therefore identify and examine the characteristics, such as ranking, publica- tion year, publishing journal, publication type, and author- ship, of the most frequently cited articles published in EM journals.

Materials and methods

We selected 9 of the 11 journals listed under the subject category bEmergency MedicineQ on the Journal Citation Report 2003 for analysis, which included Annals of Emergency Medicine, Academic Emergency Medicine, American Journal of Emergency Medicine, Resuscitation, Journal of Emergency Medicine, Emergency Medicine Journal, Unfallchirurg, Injury, and Pediatric Emergency Care. We excluded Journal of Burn Care & Rehabilitation for analysis because its contents are beyond the scope of most emergency physicians’ daily practice. We also

excluded Emergency Medicine Clinics of North America because it was not a peer-reviewed journal. Of the articles published since 1972, 237 were cited more than 50 times and 113 were cited more than 70 times. Cited times for each article were identified using the database of the Science Citation Index Expanded (1972 to present). The Science Citation Index Expanded is a multidisciplinary database powered by the ISI and its Web of Science with searchable author abstracts covering the journal literature of the sciences; it indexes more than 5700 major journals across 164 scientific disciplines, providing access to the current information and retrospective data from 1945 forward, and contains a current total of more than 17 million records with an average of 17750 new records per week. The Cited Reference Search option of the Web of Science returns a site- figured maximum number of results, which is limited to 500. The data can be searched in segments, for example, by searching 1 year or 1 journal for data at a time to find more than the maximum number of results. Data stored for each reference in the database include, among other categories, the title, author name, institutions and addresses, journal, abstract, and keywords. The 100 top-cited articles in EM journals were read and revealed online (PubMed), obtained

Fig. 1 Fields of top-cited articles in Emergency Medicine Journals.

in a printed format, analyzed, and tabulated according to their specific features. Statistical analysis was performed using the SPSS version 13.0 (SPSS, Chicago, Ill). Mann- Whitney U tests and Kruskal-Wallis tests were used to compare groups. P V .05 was considered significant.


Top-cited articles in EM journals

Two hundred thirty-seven articles were retrieved that were published in EM journals and that were cited 50 times or more. Using the Web of Science update of April 25, 2005, we selected the top 100 most frequently cited articles from the list for further analysis and ranking (Table 1). The most cited article received 335 citations and the 3 least cited articles received 71 citations. The median citation number of these 100 articles was 102 (range, 71-335). The majority (72 articles) received more than 80 citations. Of the 11 EM journals, 6 published all the 100 top-cited articles, led by Annals of Emergency Medicine with 66 articles (66%), followed by American Journal of Emergency Medicine, 22 (22%); Injury, 5 (5%); Resuscitation, 5 (5%); Journal of

Emergency Medicine, 1 (1%); and Unfallchirurg, 1 (1%) article. The mean citation number between the first 2 journals was not significantly different ( P = .13).

Publication type

Of the 100 top-cited articles in EM journals, 81 (81%) articles were original contributions and 19 (19%) were review articles. Of 90 original contributions, clinical study was the main type of study (53, 53%), followed by population-based Epidemiological study (20, 20%), review

articles (19, 19%), and Animal experimental study (8, 8%). Mean citation number was not significantly different among different publication types ( P = .1).

Fields of study

The main study fields in EM journals were toxicology (30, 30%), traumatology (19, 19%), resuscitation medicine

(17, 17%), cardiovascular medicine (10, 10%), pediatrics

(7, 7%), and emergency medical service (6, 6%) (Fig. 1). Some sporadic topics concerning pulmonary medicine (2), analgesia (2), health care service and utility (2), ultrasound (1), medicolegal problems (1), gastroenterology (1), ortho- pedics (1), and domestic violence (1) were categorized as miscellaneous (11, 11%). The median citation number in each category was between 84 and 110.5, led by cardiovascular medicine 110.5 (range, 76-204) and resus- citation medicine 95 (range, 71-335), but difference of mean citation number among various categories was insignificant ( P = .317).

Table 2 List of authors who contributed more than 5 citation classics in EM

Author No. of classics

Litovitz, TL 17

Gibler, WB 5

Eisenberg, MS


Cummins, RO


Todd KH


Position on author list

First author–17 First author–4, seventh author–1 First author–2, second author–4 First author–2, third author–2, fourth author–1 First author–2

Author institution

American Association of Poison Control Centers, Washington, DC University of Cincinnati, Department of Emergency Medicine, Cincinnati, OH

University of Washington, King County Health Department, Div of Emergency Medical Services, Seattle, WA

University of Washington, Department of Emergency Medicine, Seattle, WA

Emory University, Department of Surgery, Division of

Emergency Medicine, Atlanta, GA

Annals of

66 (66)

90 (71-335)





22 (22)

97.5 (73-140)


Journal of




5 (5)

83 (72-96)



5 (5)

72 (75-147)


Journal of

1 (1)

92 (92)





1 (1)

88 (88)


Publication year

Table 3 List of authors who contributed more than 5 citation classics in EM

Journal title No. of citation Cited times, ISI 2003 classics (%) median (range) impact factor

Most top-cited articles (92, 92%) were published between 1980 and 1999, with an approximately equal distribution in the 1980s (44%) and the 1990s (48%). Years 1993 and 1985 were the most productive years, which published 12 and 9 top-cited articles, respectively.


The United States contributed 85 (85%) citation classics, followed by Canada with 3 (3%) articles. Only 8 (8%) articles originated from non-English-speaking countries.

The specialty backgrounds of the first authors in citation classics were as follows: EM, 52%; surgery, 3%; internal medicine, 12%; biomedical engineering, 2%; family med- icine, 1%; psychiatry, 1%; and laboratory for experimental research, 4%. Group authorship accounted for 25% of top- cited articles. Median citation number between EM authors (median, 87; range, 71-335) and other specialty authors (median, 94; range, 72-235) was not different significantly ( P = .385). We found some bfrequent authorsQ who contributed more than 2 citation classics as first authorship (Table 2). Toby L. Litovitz led the list in EM journals, who was the first author of a series of 17 annual reports of the national data on poisoning from the American Association of Poison Control Centers.


Citations of an article are only one limited measure of its effect and usefulness, but also currently the only one that is quantifiable. Our study identified and characterized the 100 top-cited articles published on EM journals in the past 3 decades, providing an encyclopedic view of the citation frequency of these top-cited articles. The information may help those who want to find the history, evolution, and areas of intensive research activities of EM.

Previous study found that the impact factor of the original publishing journal was the strongest predictor of citations [4]. Our results, however, indicated that among the top-cited articles, citation outcome was not affected by the journal’s impact factor (Table 3). Our results showed that most of the citation classics were generated by few countries and few journals. The origin of citation classics is even more concentrated in the United States in EM as compared to general surgical journals (78% US) [5], clinical dermato- logic journals (75% US) [6], otolaryngology–head and neck surgery journals (84% US) [7], and anesthetic journals (69% US) [8]. In addition to the overwhelming influence that the United States has on medical research, the dominance might even be fostered by a tendency for American authors to cite local papers and for authors in other parts of the world to publish in and cite American journals. Besides, EM has not been recognized as an independent clinical specialty in many European countries, and many research results concerning EM may thus submit to other Specialty journals.

Emergency medicine is viewed as an integrated horizon- tal body of medical knowledge concerning the acute phases of all types of disease, which is reflected on the diversified author backgrounds and research topics. Previous work noted that publications in non-EM journals tend to have more authors from disciplines other than EM and cover more research topics [9,10]. Despite the diversity in research topics, topics concerning toxicology, traumatology, resusci- tation of the out-of-hospital cardiac arrest, and myocardial infarction stood on the center of stage, which in total accounted for 76% of top-cited articles. Review articles instead of the original articles tend to be cited frequently and have a high impact in recent years because the number of references in most journals is limited [11]. Our study reveals this trend that the number one place of the top-cited article was a review article.

Although we have tried to eliminate potential flaws in our citation analysis, some limitations were inevitable and are linked to the inherent problems of citation analysis [4,12,13]. The citation of a scientific article usually followed a time course, which is usually not cited until 1 to 2 years after publication, reaches a maximum after 3 to

10 years, then declines. This normal life span of a publication shows that evaluating the rank and significance of recent publications is, at best, limited. Other problems include biased citing, such as self-citation, citing high- impact journals, citing the latest but not milestone articles, and national or Language preferences. In addition, because a substantial proportion (32%) of studies presented on an EM meeting may be subsequently submitted to non-EM journals, presumably because of the increased prestige of these journals [14], the articles listed here may only reflect part of the milestone works in the field of EM.

In conclusion, this study has identified and compared some important features of the most cited EM articles ever published on the EM journals. Although citation index is not

a measure of quality or importance, it is now widely accepted as a measure of recognition. Citation analysis in this work tells information about the trends and some important advances in the evolution of EM. In addition, despite the relative low impact factors of EM journals, truly, milestone works will withstand the test of time and greatly influence the scientific community in due course.


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