Article

The top 100 cited articles published in emergency medicine journals

a b s t r a c t

Introduction: Our objective was to identify trends and examine the characteristics of the top 100 cited articles in emergency medicine (EM) journals.

Methods: Scopus Library database was queried to determine the citations of the top 100 EM articles. A second database (Google Scholar) was used to gather the following information: number of authors, Publication year, journal name, Impact Factor, country of origin, and article type (original article, review article, conference paper, or editorial). The top 100 cited articles were selected and analyzed by 2 independent investigators.

Results: We identified 100 Top-cited articles published in 6 EM journals, led by Annals of Emergency Medicine (65) and American Journal of Emergency Medicine (15). All top-cited articles were published between 1980 and 2009. The common areas of study were categorized as cardiovascular medicine, emergency department administra- tion, toxicology, pain medicine, pediatrics, traumatology, and resuscitation. A statistically significant association was found between the journal impact factor and the number of top 100 cited articles (P b .005).

Conclusion: The top-cited articles published in EM journals help us recognize the quality of the works, discoveries, and trends steering EM. Our analysis provides an insight to the prevalent areas of study being cited within our field of practice.

(C) 2015

Introduction

With the growth of medical literature that has occurred in the last century, there has been a simultaneous progress in the field of bibliometrics. Bibliometrics is the quantitative analysis of research pub- lications. One such measure is citation analysis, which quantifies the number and relationship of references that an article receives over time. Such knowledge can facilitate research allocation and reorienta- tion of research support, rationalize research organizations, restrict re- search in particular fields, or enhance research productivity. Literature in emergency medicine (EM) has undergone significant developments in the last few decades and is now evolving at a rapid pace largely in part to the evolution of the field [1-9].

A previous analysis of the most commonly cited EM studies found that the Fields of study which accounted for the majority of interest in the scientific community were clinical (toxicology, 30%; trauma, 19%; resuscitation medicine, 17%; cardiovascular, 10%; pediatrics, 7%) [10].

? Disclosure: There are no conflicts of interests. There was no commercial funding for this study. The authors have full control over all the data. The study will not be published elsewhere in any language without the consent of the copyright owners.

* Corresponding author. Division of Emergency Radiology, Department of Radiology and Imaging, Emory University Hospital, 550 Peachtree St NE, Atlanta, GA 30308. Tel.: +1 404 686 5957 (Office); fax: +1 404 686 4498.

E-mail address: [email protected] (W. Shuaib).

Considering the evolutionary nature of EM, these trends may have shifted. More efforts are now being made to understand the logistics of Patient throughput, shorter turnaround times, and cost-effectiveness [11-14] along with other logistical issues dealing with emergency department (ED) overcrowding [15-18].

The objective of our study was to provide an analysis of the EM body of literature and identify the Most frequently cited EM publications and identify important characteristics, such as top-cited journals, Field of Study, article characteristics, article rankings, and publication year, and identify authors steering the literature in the field of EM.

Methods

Data acquisition

In December 2014, we searched the Scopus Library database (www.scopus.com) for citations of published EM literature. Fifteen journals are listed under the Institute of Science Information Web of Science subject category “emergency medicine, emergency department, and emergency room.” The following journals were included in our inves- tigation: Annals of Emergency Medicine, The American Journal of Emergency Medicine, Academic Emergency Medicine, Journal of Emergency Medicine, Emergency Medicine Journal, European Journal of Emergency Medicine,

http://dx.doi.org/10.1016/j.ajem.2015.04.047

0735-6757/(C) 2015

Table 1

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

Rank

Article

Citations

1.

Watson WA, Litovitz TL, Rodgers Jr GC et al. 2002 Annual report of the American Association of Poison control centers Toxic Exposure Surveillance System.

954

2.

AM J EMERG MED 2003;21:353-412.

Watson WA, Litovitz TL, Klein-Schwartz W et al. 2003 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance

953

3.

System. AM J EMERG MED 2004;22:335-404.

Eisenberg MS, Horwood BT, Cummins RO, Reynolds-Haertle R, Hearne TR. Cardiac arrest and resuscitation: a tale of 29 cities. Annals of Emergency Medicine

924

4.

1990;19:179-186.

Cummins RO, Chamberlain DA, Abramson NS et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein

904

5.

style. Task Force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Ann Emerg Med 1991;20:861-74.

Larsen MP, Eisenberg MS, Cummins RO, Hallstrom AP. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Annals of Emergency Medicine

884

1993;22:1652-1658.

6.

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Annals of Emergency Medicine 1986;15:557-564.

707

7.

Baraff LJ, Bass JW, Fleisher GR et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Annals of

686

8.

Emergency Medicine 1993;22:1198-1210.

Derlet RW, Richards JR. Overcrowding in the nation’s emergency departments: Complex causes and disturbing effects. Annals of Emergency Medicine 2000;35:63-68.

681

9.

Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med 2001;8:1153-1157.

608

10.

Becker LB, Ostrander MP, Barrett J, Kondos GT. Outcome of CPR in a large metropolitan area–where are the survivors? Annals of Emergency Medicine

602

11.

1991;20:355-361.

Todd KH, Funk KG, Funk JP, Bonacci R. Clinical significance of reported changes in Pain severity. Annals of Emergency Medicine 1996;27:485-489.

600

12.

Gilbert EH, Lowenstein SR, Koziol-McLain J, Barta DC, Steiner J. Chart reviews in emergency medicine research: where are the methods? Annals of Emergency

575

13.

Medicine 1996;27:305-308.

Bar-Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia–a preliminary report. J EMERG

539

14.

MED 2000;19:311-315.

Litovitz TL, Klein-Schwartz W, White S et al. 2000 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.

529

15.

AM J EMERG MED 2001;19:337-395.

Litovitz TL, Klein-Schwartz W, White S et al. 1999 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.

529

16.

AM J EMERG MED 2000;18:517-574.

Harrison A, Morrison LK, Krishnaswamy P et al. B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department

522

17.

with dyspnea. Annals of Emergency Medicine 2002;39:131-138.

Katz SH, Falk JL. Misplaced Endotracheal tubes by paramedics in an urban emergency medical services system. Annals of Emergency Medicine 2001;37:32-37.

501

18.

McCarthy BD, Beshansky JR, D’Agostino RB, Selker HP. missed diagnoses of acute myocardial infarction in the emergency department: results from a

498

19.

multicenter study. Annals of Emergency Medicine 1993;22:579-582.

Ericsson KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med 2008;15:988-994.

487

20.

Gibler WB, Runyon JP, Levy RC et al. A rapid diagnostic and treatment center for patients with chest pain in the emergency department. Annals of Emergency

474

21.

Medicine 1995;25:1-8.

Stiell IG, Greenberg GH, McKnight RD, Nair RC, McDowell I, Worthington JR. A study to develop clinical decision rules for the use of radiography in acute ankle

456

22.

injuries. Annals of Emergency Medicine 1992;21:384-390.

Okumura T, Takasu N, Ishimatsu S et al. Report on 640 victims of the Tokyo subway sarin attack. Annals of Emergency Medicine 1996;28:129-135.

446

23.

Watson WA, Litovitz TL, Rodgers Jr GC et al. 2004 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance System.

442

24.

AM J EMERG MED 2005;23:589-666.

Tatum JL, Jesse RL, Kontos MC et al. Comprehensive strategy for the evaluation and triage of the chest pain patient. Annals of Emergency Medicine 1997;29:116-125.

442

25.

Derlet RW, Richards JR, Kravitz RL. Frequent overcrowding in U.S. emergency departments. Acad Emerg Med 2001;8:151-155.

437

26.

Todd KH, Deaton C, D’Adamo AP, Goe L. Ethnicity and analgesic practice. Annals of Emergency Medicine 2000;35:11-16.

437

27.

Clyne B, Olshaker JS. The C-reactive protein. J EMERG MED 1999;17:1019-1025.

437

28.

Hoot NR, Aronsky D. Systematic review of emergency department crowding: causes, effects, and solutions. Annals of Emergency Medicine 2008;52:126-136.e1.

432

29.

Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of

426

30.

interventions. Annals of Emergency Medicine 2002;39:238-247.

Risser DT, Rice MM, Salisbury ML, Simon R, Jay GD, Berns SD. The potential for improved teamwork to reduce Medical errors in the emergency department.

426

Annals of Emergency Medicine 1999;34:373-383.

31.

Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Annals of

418

32.

Emergency Medicine 2001;38:633-638.

Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003;20:402-405.

415

33.

Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC. Role of “ischemia modified albumin”, a new biochemical marker of myocardial ischaemia, in the early

407

34.

diagnosis of acute coronary syndromes. Emerg Med J 2004;21:29-34.

Asplin BR, Magid DJ, Rhodes KV, Solberg LI, Lurie N, Camargo Jr CA. A conceptual model of emergency department crowding. Annals of Emergency Medicine

404

35.

2003;42:173-180.

Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, Perdreau-Remington F. High prevalence of methicillin-resistant Staphylococcus aureus in emergency

400

36.

department skin and soft tissue infections. Annals of Emergency Medicine 2005;45:311-320.

Wright RO, Lewander WJ, Woolf AD. Methemoglobinemia: etiology, pharmacology, and clinical management. Annals of Emergency Medicine 1999;34:646-656.

398

37.

Bernard SA, Jones BM, Horne MK. Clinical trial of induced hypothermia in comatose survivors of out-of-hospital cardiac arrest. Annals of Emergency Medicine

396

38.

1997;30:146-153.

Cummins RO, Eisenberg MS, Hallstrom AP, Litwin PE. Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. AM J

387

39.

EMERG MED 1985;3:114-119.

Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. Cincinnati prehospital stroke scale: reproducibility and validity. Annals of Emergency Medicine 1999;33:373-378.

373

40.

Litovitz TL, Klein-Schwartz W, Rodgers Jr GC et al. 2001 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance

364

41.

System. AM J EMERG MED 2002;20:391-451.

Wright DW, Kellermann AL, Hertzberg VS et al. ProTECT: A randomized clinical trial of progesterone for acute traumatic brain injury. Annals of Emergency

360

42.

Medicine 2007;49:391-402.e2.

Kelly AM. The minimum clinically significant difference in Visual analogue scale pain score does not differ with severity of pain. Emerg Med J 2001;18:205-207.

360

43.

Chisholm CD, Collison EK, Nelson DR, Cordell WH. Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and

360

44.

“multitasking”? Acad Emerg Med 2000;7:1239-1243.

Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med 2002;9:1184-1204.

345

45.

Rupp T, Delaney KA. Inadequate analgesia in emergency medicine. Annals of Emergency Medicine 2004;43:494-503.

344

46.

Stern SA, Dronen SC, Birrer P, Wang X. Effect of blood pressure on hemorrhage volume and survival in a near-fatal hemorrhage model incorporating a vascular

342

(continued on next page)

Table 1 (continued)

Rank

Article

Citations

47.

injury. Annals of Emergency Medicine 1993;22:155-163.

Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Annals of

341

48.

Emergency Medicine 1998;31:325-332.

Cales RH. Trauma mortality in Orange County: the effect of implementation of a regional Trauma system. Annals of Emergency Medicine 1984;13:1-10.

341

49.

Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med 1998;5:1086-1090.

338

50.

Wilson JE, Pendleton JM. Oligoanalgesia in the emergency department. AM J EMERG MED 1989;7:620-623.

337

51.

Green SM, Rotbrock SG, Lynch EL et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Annals of

323

52.

Emergency Medicine 1998;31:688-697.

Stiell IG, Wells GA. Methodologic standards for the development of clinical decision rules in emergency medicine. Annals of Emergency Medicine 1999;33:437-447.

322

53.

White RD, Asplin BR, Bugliosi TF, Hankins DG. High discharge survival rate after out-of-hospital ventricular fibrillation with rapid defibrillation by police and

322

54.

paramedics. Annals of Emergency Medicine 1996;28:480-485.

Shapiro NI, Howell MD, Talmor D et al. Serum lactate as a predictor of mortality in emergency department patients with infection. Annals of Emergency

321

55.

Medicine 2005;45:524-528.

Wuerz RC, Milne LW, Eitel DR, Travers D, Gilboy N. Reliability and validity of a new five-level triage instrument. Acad Emerg Med 2000;7:236-242.

321

56.

Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB. Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by

318

57.

treatment with Hyperbaric oxygen. Annals of Emergency Medicine 1995;25:474-480.

Trzeciak S, Dellinger RP, Parrillo JE et al. Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to

316

58.

hemodynamics, oxygen transport, and survival. Annals of Emergency Medicine 2007;49:88-98.e2.

Doyle CJ, Post H, Burney RE, Maino J, Keefe M, Rhee KJ. Family participation during resuscitation: an option. Annals of Emergency Medicine 1987;16:673-675.

315

59.

Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, adverse drug-related events, and potential adverse Drug interactions in elderly patients presenting

311

60.

to an emergency department. Annals of Emergency Medicine 2001;38:666-671.

Rosetti VA, Thompson BM, Miller J, Mateer JR, Aprahamian C. Intraosseous infusion: an alternative route of pediatric intravascular access. Annals of Emergency

310

61.

Medicine 1985;14:885-888.

Bernstein SL, Aronsky D, Duseja R et al. The effect of emergency department crowding on clinically oriented outcomes. Acad Emerg Med 2009;16:1-10.

308

62.

Nichol G, Stiell IG, Laupacis A, Pham B, De Maio VJ, Wells GA. A cumulative meta-analysis of the effectiveness of defibrillator-capable emergency medical

306

63.

services for victims of out-of-hospital cardiac arrest. Annals of Emergency Medicine 1999;34:517-525.

Gennarelli TA. Mechanisms of brain injury. J EMERG MED 1993;11:5-11.

301

64.

Thompson DA, Yarnold PR, Williams DR, Adams SL. Effects of actual waiting time, perceived waiting time, information delivery, and expressive quality on

299

65.

patient satisfaction in the emergency department. Annals of Emergency Medicine 1996;28:657-665.

Rusnak RA, Stair TO, Hansen K, Fastow JS. Litigation against the emergency physician: common features in cases of missed myocardial infarction. Annals of

298

66.

Emergency Medicine 1989;18:1029-1034.

Litovitz TL, Klein-Schwartz W, Caravati EM, Youniss J, Crouch B, Lee S. 1998 Annual report of the American Association of Poison Control Centers Toxic

296

67.

Exposure Surveillance System. AM J EMERG MED 1999;17:435-487.

Young KD, Seidel JS. Pediatric cardiopulmonary resuscitation: a collective review. Annals of Emergency Medicine 1999;33:195-205.

296

68.

Sirbaugh PE, Pepe PE, Shook JE et al. A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital

294

69.

pediatric cardiopulmonary arrest. Annals of Emergency Medicine 1999;33:174-184.

Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg

293

70.

Med 2003;10:390-392.

D’Onofrio G, Degutis LC. Preventive care in the emergency department: screening and brief intervention for alcohol problems in the emergency department: a

290

71.

systematic review. Acad Emerg Med 2002;9:627-638.

Schull MJ, Vermeulen M, Slaughter G, Morrison L, Daly P. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Annals of

288

72.

Emergency Medicine 2004;44:577-585.

Kulig K, David BO, Cantrill SV, Rosen P, Rumack BH. Management of acutely Poisoned patients without gastric emptying. Annals of Emergency Medicine 1985;14:562-567.

286

73.

Green SM, Johnson NE. ketamine sedation for pediatric procedures: part 2, review and implications. Annals of Emergency Medicine 1990;19:1033-1046.

284

74.

Wightman JM, Gladish SL. Explosions and blast injuries. Annals of Emergency Medicine 2001;37:664-678.

284

75.

Litovitz TL, Klein-Schwartz W, Dyer KS, Shannon M, Lee S. 1997 Annual report of the American Association of Poison Control Centers Toxic Exposure

281

76.

Surveillance System. AM J EMERG MED 1998;16:443-497.

Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax.

279

77.

Acad Emerg Med 2005;12:844-849.

Stiell IG, Wells GA, DeMaio VJ et al. Modifiable factors associated with improved Cardiac arrest survival in a multicenter basic life support/defibrillation

278

78.

system: OPALS study phase I results. Annals of Emergency Medicine 1999;33:44-50.

Baraff LJ. Management of fever without source in infants and children. Annals of Emergency Medicine 2000;36:602-614.

266

79.

Battaglia J, Moss S, Rush J et al. Haloperidol, lorazepam, or both for psychotic agitation? A multicenter, prospective, double-blind, emergency department

262

80.

study. AM J EMERG MED 1997;15:335-340.

Selbst SM, Clark M. Analgesic use in the emergency department. Annals of Emergency Medicine 1990;19:1010-1013.

260

81.

Martin TP, Hanusa BH, Kapoor WN. Risk stratification of Patients with syncope. Annals of Emergency Medicine 1997;29:459-466.

259

82.

Litovitz TL, Smilkstein M, Felberg L, Klein-Schwartz W, Berlin R, Morgan JL. 1996 Annual report of the American Association of Poison Control Centers Toxic

Exposure Surveillance System. AM J EMERG MED 1997;15:447-500.

257

83.

Pines JM, Hollander JE. Emergency department crowding is associated with poor care for patients with severe pain. Annals of Emergency Medicine 2008;51:1-5.

253

84.

Mosesso VN, Jr., Davis EA, Auble TE, Paris PM, Yealy DM. Use of automated external defibrillators by police officers for treatment of out-of-hospital cardiac

250

85.

arrest. Annals of Emergency Medicine 1998;32:200-207.

Bullock R, Chesnut RM, Clifton G et al. Guidelines for the management of severe head injury. Brain Trauma Foundation. European journal of emergency

249

86.

medicine: official journal of the European Society for Emergency Medicine 1996;3:109-127.

Douglas Weaver W, Cobb LA, Hallstrom AP et al. Considerations for improving survival from out-of-hospital cardiac arrest. Annals of Emergency Medicine 1986.

247

87.

Gallagher MJ, Ross MA, Raff GL, Goldstein JA, O’Neill WW, O’Neil B. The diagnostic accuracy of 64-slice Computed tomography coronary angiography

compared with stress nuclear imaging in emergency department Low-risk chest pain patients. Annals of Emergency Medicine 2007;49:125-136.

245

88.

Anderson DK, Hall ED. Pathophysiology of spinal cord trauma. Annals of Emergency Medicine 1993;22:987-992.

245

89.

Donoghue AJ, Nadkarni V, Berg RA et al. Out-of-hospital Pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge. Annals of

233

90.

Emergency Medicine 2005;46:512-522.

Hoekstra JW, Pollack Jr CV, Roe MT et al. Improving the care of patients with non-ST-elevation acute coronary syndromes in the emergency department: the

229

91.

CRUSADE initiative. Acad Emerg Med 2002;9:1146-1155.

Young W. Secondary injury mechanisms in acute spinal cord injury. J EMERG MED 1993;11:13-22.

227

92.

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;12:546-584.

221

93.

Mogayzel C, Quan L, Graves JR, Tiedeman D, Fahrenbruch C, Herndon P. Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. Annals of Emergency Medicine 1995;25:484-491.

218

Table 1 (continued)

Rank

Article

Citations

94.

Litovitz TL, Felberg L, White S, Klein-Schwartz W. 1995 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance

217

95.

System. AM J EMERG MED 1996;14:487-537.

Pena BMG, Krauss B. Adverse events of Procedural sedation and analgesia in a pediatric emergency department. Annals of Emergency Medicine 1999;34:483-491.

215

96.

Quinn JV, Stiell IG, McDermott DA, Sellers KL, Kohn MA, Wells GA. Derivation of the San Francisco Syncope Rule to predict patients with short-term serious

208

97.

outcomes. Annals of Emergency Medicine 2004;43:224-232.

Hickey RW, Cohen DM, Strausbaugh S, Dietrich AM. Pediatric patients requiring CPR in the prehospital setting. Annals of Emergency Medicine 1995;25:495-501.

201

98.

Lambrew CT, Smith MS, Annas GG et al. Emergency department: rapid identification and treatment of patients with acute myocardial infarction. Annals of

200

99.

Emergency Medicine 1994;23:311-329.

Litovitz TL, Felberg L, Soloway RA, Ford M, Geller R. 1994 Annual report of the American Association of Poison Control Centers Toxic Exposure Surveillance

195

100.

System. AM J EMERG MED 1995;13:551-597.

emergency ultrasound guidelines. Annals of Emergency Medicine 2009;53:550-570.

181

Resuscitation, Injury, Pediatric Emergency Care, Journal of Burn Care and Rehabilitation, Air Medical Journal, and Unfallchirurg were included in our investigation. In this list, Journal of Burn Care and Rehabilitation and Air Medical Journal were excluded because their content is beyond the scope of most emergency physicians’ daily practice [10]. No time limita- tions were implemented on the investigation. In addition, we did not impose any restriction based on study types, availability of an abstract, and human vs nonhuman research subjects.

All available electronic copies of the top-cited articles were collected. In cases where electronic copies were unavailable, hard copies were sought from interlibrary loan service. The list of journals identified was exported into a spreadsheet. All identified journals were collected in a single search. Our search yielded a list of all indexed published articles in each of the journals. The results were arranged by using the option “Times cited,” which provided us a list of all the articles, pub- lished in a specific journal ranked by citation counts. An independent search on Google Scholar was conducted to cross-reference and verify each citation count.

Using the modified approach of the methods by Lim et al [19], 2 inde- pendent investigators reviewed the 100 articles, and the following data were compiled: number of authors, publication year, journal name, impact factor, country of origin, and article type (original article, review article, conference paper, or editorial). If there were authors from multiple countries, country of origin was determined using the country that the first author belonged to. The article type of top 100 most cited list was checked independently for each article. We also reviewed the association between journal impact factor and the number of articles included in the top 100 articles. Only the journals with at least 1 of the top 100 cited articles were included in our investigation. The immediacy index was obtained from ResearchGate (www.researchgate.net).

Statistical analysis

Using the Spearman rank correlation coefficient, we evaluated the strength and direction of the linear relationship between the impact

Figure. Top 100 articles and the year of publication.

factor of the journal and the number of top 100 cited articles included in the list. The statistical software packages used for data analysis were Stata/MP 10.0 (Stata, College Station, TX). Data are presented as medians and interquartile ranges. A significance level of ? = .05 was used for all the comparisons. Our investigation did not require institu- tional review board approval, as routine data were used in the analysis.

Results

Citation count and publication year

The number of citations for the top 100 cited articles ranged from 181 to 954 (Table 1). The median number of citations was 330 (interquartile range, 157.5). The median number of authors was 4 (interquartile range, 5). The top 100 articles were published between 1980 and 2009, with most articles (n = 35) published in the 5-year period between 1996 and 2000 (Figure).

Top-cited articles in EM journals

The journal with the highest number of top 100 cited articles was An- nals of Emergency Medicine, with 65 (Table 2) followed by The American Journal of Emergency Medicine, with 15. Academic Emergency Medicine, Journal of Emergency Medicine, Emergency Medicine, and European Journal of Emergency Medicine contributed 12, 4, 3, and 1 top cited articles, respectively. The impact factors for journals with the top 100 cited articles ranged from 1.15 to 4.3. We found a statistically significant asso- ciation between journal impact factor and the number of top 100 cited articles (P b .005).

Origins, publication type, and authorship

There were 5 different countries of origin for the highly cited articles. The United States had the largest number of articles, with 87. Canada and Australia published 8 and 3 articles, respectively, whereas Japan and England contributed 1 article each to the list. The last article on the list did not have name of the authors listed as it was published by the American College of Emergency Physicians. Twenty-three articles were review articles, 3 were conference papers, and 1 editorial, whereas the other 73 were original articles. Table 3 lists the top 5 authors, each with 4 or more articles in our top 100 most cited articles list.

Table 2

Total articles according to journal and their impact factor

Journal

Total articles

Impact factor

Immediacy index

Annals of Emergency Medicine

65

4.3

1.01

The American Journal of Emergency Medicine

15

1.15

0.26

Academic Emergency Medicine

12

2.2

0.45

Journal of Emergency Medicine

4

1.17

0.16

Emergency Medicine Journal

3

1.7

0.34

European Journal of Emergency Medicine

1

1.5

0.24

Table 3

Top 5 authors with 4 or more articles in the top 100 articles

Author

Total citations

Authorship position

Author affiliations

First Last Other

Litovitz TL

12

9 – 3

American Association of Poison Control Centers, Washington, DC

Stiell IG

6

3 1 2

Clinical Epidemiology Unit, Hosp. Loeb Health Research Institute, Ottawa, Ontario, Canada

Wells GA

5

– 3 2

Clinical Epidemiology Unit, Hosp. Loeb Health Research Institute, Ottawa, Ontario, Canada

Eisenberg MS

4

1 1 2

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

Cummins RO

4

2 – 2

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

Areas of study

Key study areas in EM journals were cardiovascular medicine (20%), toxicology (15%), pain medicine (12%), pediatrics (9%), trauma (7%), resuscitation medicine (3%), emergency medical services (3%), and ED administration (13%). The remaining articles were categorized as miscellaneous (18%).

Discussion

Using bibliometrics to analyze literature published in EM journals allows us to uncover trends in the historical development of our field. Patterns of authorship, publication, and use of these publications help us develop an understanding of the prevalent areas of interest in our scientific community.

We observed that a large majority of the most highly cited articles in EM focused on numerous subjects ranging from interdisciplinary medicine to studying the national trends of ED occupancy [20-26]. This can have important implications for the stakeholders and journal editors in selecting and evaluating scientific works in the field of EM. Moreover, knowledge and understanding of the features inherent to highly cited work could help young researchers in publishing effectively.

In their citation analysis of EM literature, Tsai et al [10] reported that the topics concerning toxicology, traumatology, and Resuscitative medicine were the top 3 fields of study during their analysis of the literature. These trends, however, have changed in our analysis of the literature. Although toxicology (the Annual Report of the American Association of poison centers Toxic Exposure Surveillance System accounts for 12 of the top 100) remains common, cardiovascular medicine, pain management, and ED administration are areas of study which have grown since the 2003 analysis.

Of the top 100 cited articles, 73 were original research articles, and 23 were review articles. It is worth noting that 87 of the top 100 articles came from authors within the United States. This is in part credited to how integral the field of EM has become to the US medical system, also becoming a model for most countries developing new systems of emergency care and who look to recapitulate the sequence of steps taken to establish the systems of emergency medicine in the United States [6,27,28].

Previous literature argues that the impact factor of the journal is a strong predictor of citation count [29]. We found that the most highly cited articles were published in only 6 different journals. More than half (n = 65) of these articles were published in Annals of Emergency Medicine, which has an impact factor of 4.3 and immediacy index of 1.01, which indicates how quickly articles in a journal are cited. Our findings support the application of Bradford’s law, a bibliometric con- cept suggested by Brookes [30,31]. The principle idea behind Bradford’s law is that most researchers obtain their citations from a few main journals in their respective field of expertise. When the researchers deviate from these Core journals, their citation frequency and impact are weakened. Consequently, this tendency leads to a large percentage of citations stemming from a few core journals.

As with any other bibliometric analyses, there are many potential limitations in this study. First, this type of analysis usually favors older published articles and omits landmark articles from the most recent

10 years [32,33]. Second, there are potential shortcomings of the data- base used and exclusion of textbooks in this methodology. Scopus has been reported to miss older citations; this might have resulted in omis- sion of articles before 1980 [34,35]. Finally, there is a view that journal citations can be skewed either by authors heavily citing their own work or by large numbers of people questioning apparently badly researched findings.

Conclusion

Recognizing the top 100 most cited EM articles is one way of mea- suring the drivers of progress in EM, where the field has been and the direction it is headed. An appraisal of top-cited articles is of significance on several fronts, as it identifies the qualities of the works, discoveries, and the findings steering EM.

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