Article

Bibliometric analysis of top 100 most-cited clinical studies on ultrasound in the Emergency Department

a b s t r a c t

Study objective: We identify and characterize the most highly cited articles related to ultrasonographic evalua- tions occurring in the emergency department.

Method: We retrieved the top 100 articles in terms of citations pertaining to Ultrasonographic evaluations in the emergency department from the Scopus database. We determined the number of citations of each article, the number of citations per year, the number of Google Scholar citations, the ultrasonographical study fields, the number of patients evaluated in each study, and the specialties of the researchers conducting the studies and ul- trasonographies. We then used the ANOVA test to compare the multivariate groups.

Results: The median citation number of the articles in the Scopus database was 115 (range: 75-681), and the number of citations per year was 7.5 (range: 3.8-40.1). Focused assessment with sonography in trauma and non-traumatic Abdominal ultrasonography were conducted in 32 and 13 studies, respectively. The primary au- thors were emergency medicine specialists in 46 studies. We found that vascular and lung ultrasonography stud- ies were characterized by the largest number of citations per year.

Conclusion: The Most frequently cited studies conducted in the emergency department pertaining to the use of ultrasonography included a wide range of topics, and approximately half of the primary authors of these studies were emergency medicine specialists.

Introduction

Since the 1940s, when medical ultrasonographic systems were first developed, ultrasonography has been widely used in many medical spe- cialties [1]. It has become a routine part of emergency care in recent years. ultrasonographic imaging in the emergency department has been extended beyond tissue-based classical imaging procedures to cre- ate sonographical applications for specialized clinical referrals (e.g., focused abdominal sonography for trauma [FAST], shock protocols, and interventional procedures).

The growing number of publications on emergency ultrasonography in the last 20 years has contributed to the development of specialized emergency ultrasonographic imaging procedures [2]. However, the number of ultrasonography studies among the most-cited papers is less than expected [3,4]. No previous bibliographic study has evaluated publications on sonography in emergency medicine. In this study, we

* Corresponding author at: Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey. Tel.: +90 5055251075.

E-mail addresses: [email protected] (B. Bayram), [email protected] (O. Limon), [email protected] (G. Limon), [email protected] (V. Hanci).

aimed to identify the most-cited articles involving ultrasonographic evaluations in the emergency department and to describe the charac- teristics of these studies.

Method

We carried out a bibliographic, descriptive analytical study. On Jan- uary 1, 2016, to identify studies of emergency ultrasonography pub- lished in the international literature, the keywords “ultrasound and emergency” OR “ultrasonography and emergency” OR “sonography and emergency” were used as search terms in an advanced search of Scopus. The subject area was limited to medicine and human studies. The resultant publications were sorted based on the number of cita- tions, and they were evaluated. Studies that focused on the use of ultra- sound (US) in patient management for an emergency clinical situation or those where US was used as an imaging technique in the emergency department or in the prehospital setting were included in the study. Meta-analyses, reviews, and letters to the editors or studies that were conducted outside the emergency department or before referral to a hospital were excluded from the study.

After excluding 341 reviews and 57 conference papers, the abstracts of 522 articles were evaluated by two emergency medicine specialists to

http://dx.doi.org/10.1016/j.ajem.2016.03.033

Number	ARTICLE	Year	Authors	Scopus (total cite)	Citations per year	Google (total cite)
1	Non-invasive diagnosis of venous thromboembolism in outpatients.	1999	Perrier A, Desmarais S,	681	40.1	877
	Lancet. 16;353(9148):190-5.		Miron MJ, et al.
2	Prospective evaluation of surgeons’use of ultrasound in the	1993	Rozycki GS, Ochsner MG,	254	11	356
	evaluation of trauma patients. J Trauma. 34(4):516-26*		Jaffin JH et al.
3	Diagnosis of pulmonary embolism by a Decision analysis-based	1996	Perrier A, Bounameaux H,	249	12.5	299
	strategy including clinical probability, D-dimer levels, and		Morabia A, et al.
4	A prospective study of surgeon-performed ultrasound as the primary	1995	Rozycki GS, Ochsner MG,	241	11.5	374
	adjuvant modality for injured patient assessment. J Trauma.		Schmidt JA, et al.
	Sep.;39(3):492-8
5	Hand-held thoracic sonography for detecting post-traumatic	2004	Kirkpatrick AW, Sirois M,	226	18.8	374
	pneumothoraces: the Extended Focused Assessment with		Laupland KB, et al.
	Sonography for Trauma (EFAST). J Trauma. 57(2):288-95.
6	Surgeon-performed ultrasound for the assessment of truncal injuries:	1998	Rozycki GS, Ballard RB,	223	11.2	226
	lessons learned from 1540 patients. Ann Surg 228(4):557-67.		Feliciano DV, et al.
7	Prospective analysis of a rapid trauma ultrasound examination	1995	Ma OJ, Mateer JR, Ogata M, et al.	220	10.5	341
	performed by emergency physicians. J Trauma. 38(6):879-85.
8	Ultrasound in blunt abdominal and Thoracic trauma.	1993	Rothlin MA, Naf R,	207	7.5	116
	J Trauma 34(4):488-95.		Amgwerd M, et al.
9	A prospective comparison of supine chest radiography and bedside	2005	Blaivas M, Matthew L,	206	18.7	330
	ultrasound for the diagnosis of traumatic pneumothorax.		Sandeep D.
	Acad Emerg Med 12(9):844-9.
10	Diagnosis of pulmonary embolism by multidetector CT alone or	2008	Righini M, Le Gal G,	204	25.5	291
	combined with venous ultrasonography of the leg: a randomized		Aujesky D, et al.
	non-inferiority trial. Lancet 19;371(9621):1343-52.
11	Ultrasonography and limited computed tomography in the	1999	Garcia Pena BM1, Mandl KD,	202	10.6	246
	diagnosis and management of appendicitis in children.		Kraus SJ, et al.
	JAMA 15;282(11):1041-6.
12	blunt abdominal trauma in cases of multiple trauma evaluated	1992	Hoffmann R, Nerlich M,	199	8.3	272
	by ultrasonography: a prospective analysis of 291 patients.		Muggia-Sullam M, et al.
	J Trauma. 32(4):452-8.
13	Traumatic pneumothorax detection with thoracic US: correlation	2002	Rowan KR, Kirkpatrick AW,	185	13.2	269
	with chest radiography and CT-initial experience.		Liu D, et al.
	Radiology. 225(1):210-4.
14	1000 consecutive ultrasounds for blunt abdominal trauma.	1996	McKenney MG, Martin L,	178	8.9	268
	J Trauma 40(4):607-10.		Lentz K, et al.
15	Sonography in blunt abdominal trauma: a preliminary progress report.	1992	Tso P, Rodriguez A,	174	7.3	274
	J Trauma 33(1):39-43		Cooper C, et al.,
16	Prospective comparison of Diagnostic peritoneal lavage, computed	1993	Liu M, Lee CH, P’eng FK.	172	7.2	172
	tomographic scanning, and ultrasonography for the diagnosis of blunt
	abdominal trauma. J Trauma 35(2):267-70.
17	Occult traumatic pneumothorax: diagnostic accuracy of lung	2008	Soldati G, Testa A, Sher S, et al.	163	20.4	253
	ultrasonography in the emergency department. Chest133(1):204-11
18	Real-time ultrasonographically-guided internal jugular vein	2006	Leung J, Duffy M, Finckh A.	161	16.1	226
	catheterization in the emergency department increases success rates
	and reduces complications: a randomized, prospective study.
	Ann Emerg Med 48(5):540-7.
19	Computed tomography and ultrasonography do not improve and	2001	Lee SL, Walsh AJ, Ho HS.	159	11.9	279
	may delay the diagnosis and treatment of acute appendicitis.
	Arch Surg 136(5):556-62.
20	Ultrasonography-guided peripheral intravenous access versus	2005	Costantino TG, Parikh AK,	158	14	137
	traditional approaches in patients with difficult intravenous access.		Satz WA, et al.
	Ann Emerg Med 46(5):456-61.
21	Focused abdominal sonogram for trauma: the learning curve of	1999	Shackford SR, Rogers FB,	158	9.1	210
	nonradiologist clinicians in detecting hemoperitoneum.		Osler TM, et al.
	J Trauma 46(4):553-62
22	Emergency center ultrasonography in the evaluation of	1991	Kimura A, Otsuka T.	158	6.3	228
	hemoperitoneum: a prospective study. J Trauma Jan.;31(1):20-3.
23	Determination of left ventricular function by emergency physician	2002	Moore CL, Rose GA,	157	12.4	338
	echocardiography of hypotensive patients. Acad Emerg Med 9(3):186-93.		Tayal VS, et al.
24	Randomized, controlled clinical trial of point-of-care limited	2005	Milling TJ Jr., Rose J,	156	14.2	248
	ultrasonography assistance of central venous cannulation:		Briggs WM, et al.
	the Third Sonography Outcomes Assessment Program (SOAP-3) Trial.
	Crit Care Med 33(8):1764-9.
25	Abdominal injuries without hemoperitoneum: a potential limitation of	1997	Chiu WC, Cushing BM,	155	8.2	225
	focused abdominal sonography for trauma (FAST). J Trauma 42(4):617-23		Rodriguez A, et al.
26	The role of ultrasound in patients with possible penetrating cardiac	1999	Rozycki GS, Feliciano DV,	154	9.1	280
	wounds: a prospective multicenter study. J Trauma 46(4):543-51.		Ochsner MG, et al.
27	Randomized, controlled trial of immediate versus delayed goal-directed	2004	Jones AE, Tayal VS,	146	12.2	233
	ultrasound to identify the cause of nontraumatic hypotension in		Sullivan DM, et al.
	emergency department patients. Crit Care Med 32(8):1703-8.
28	Nonenhanced helical CT and US in the emergency evaluation of patients	2000	Sheafor DH, Hertzberg BS,	146	9.3	222
	with renal colic: prospective comparison. Radiology 217(3):792-7.		Freed KS, et al.
29	Can ultrasound replace diagnostic peritoneal lavage in the assessment	1994	McKenney M, Lentz K,	145	6.6	216

Table 1

The 100 most-cited clinical studies on ultrasound in the emergency department, ranked by citation frequency

ultrasonography: a management study. Arch Intern Med. 11;156(5):531-6.??

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Number	ARTICLE	Year	Authors	Scopus (total cite)	Citations per year	Google (total cite)
30	of blunt trauma? J Trauma 37(3):439-41 Bedside lung ultrasound in the assessment of alveolar-interstitial	2006	Nunez D, et al. Volpicelli G, Mussa A,	143	14.3	208
31	syndrome. Am J Emerg Med. 24(6):689-96. Ultrasound guidance versus the landmark technique for the placement	2002	Garofalo G, et al. Miller AH, Roth BA,	140	10	219
32	of central venous catheters in the emergency department. Acad Emerg Med 9(8):800-5. Ultrasound-guided brachial and basilic vein cannulation in emergency	1999	Mills TJ, et al. Keyes LE, Frazee BW,	134	7.9	198
33	department patients with difficult intravenous access. Ann Emerg Med 34(6):711-4. Outcome in cardiac arrest patients found to have cardiac standstill	2001	Snoey ER, et al. Blaivas M, Fox JC.	130	9.2	164
	on the bedside emergency department echocardiogram.
34	Acad Emerg Med 8(6):616-21. Prompt diagnosis of Ectopic pregnancy in an emergency department	1994	Barnhart K, Mennuti MT,	130	5.9	168
35	setting. Obstet Gynecol 84(6):1010-5. Quantitative sensitivity of ultrasound in detecting free	1995	Benjamin I, et al. Branney SW, Wolfe RE,	128	6.1	172
36	intraperitoneal fluid. J Trauma 39(2):375-80. suspected appendicitis in children: US and CT-a prospective	2002	Moore EE, et al. Kaiser S, Frenckner B, Jorulf HK.	127	9.1	213
37	randomized study. Radiology 223(3):633-8. 2576 ultrasounds for blunt abdominal trauma. J Trauma 50(1):108-12.	2001	Dolich MO, McKenney MG,	125	8.3	194
38	Sonography in a clinical algorithm for early evaluation of 1671	1999	Varela JE, et al. Bode PJ, Edwards MJ,	125	7.3	187
39	patients with blunt abdominal trauma. AJR Am J Roentgenol 172(4):905-11. The role of ultrasonography in blunt abdominal trauma: results in	1994	Kruit MC, et al. Goletti O, Ghiselli G,	125	5.6	123
40	250 consecutive cases. J Trauma 36(2):178-81. Abdominal ultrasound as a reliable indicator for conclusive	1993	Lippolis PV, et al. Bode PJ, Niezen RA,	125	5.4	167
41	laparotomy in blunt abdominal trauma. J Trauma 34(1):27-31. A prospective evaluation of abdominal ultrasound in blunt trauma:	1996	van Vugt AB, et al. Healey MA, Simons RK,	124	6.2	125
42	is it useful? J Trauma Jun.;40(6):875-83 Emergent abdominal sonography as a screening test in a new	1996	Winchell RJ, et al. Boulanger BR, McLellan BA,	123	6.2	193
43	diagnostic algorithm for blunt trauma. J Trauma 40(6):867-74. Evaluation of acute scrotum in the emergency department.	1995	Brenneman FD, et al. Lewis AG, Bukowski TP,	122	5.8	212
44	J Pediatr Surg30(2):277-81 ultrasound training for emergency physicians-a prospective study.	2000	Jarvis PD, et al. Mandavia DP, Aragona J,	120	7.5	113
45	Acad Emerg Med 7(9):1008-14. Sonographic evaluation of Ovarian torsion in childhood and	1988	Chan L, et al. Graif, M, Itzchak Y.	120	4.1	198
46	adolescence. AJR Am J Roentgenol 150(3):647-9. Correlation of optic nerve sheath diameter with direct measurement	2008	Kimberly HH, Shah S,	119	14.9	201
47	of intracranial pressure. Acad Emerg Med 15(2):201-4. Accuracy of emergency physician assessment of left ventricular	2003	Marill K, et al. Randazzo MR, Snoey ER,	119	8.7	189
48	ejection fraction and central venous pressure using echocardiography. Acad Emerg Med 10(9):973-7. Elevated intracranial pressure detected by bedside emergency	2003	Levitt MA, et al. Blaivas, M, Theodoro, D,	117	12	111
49	ultrasonography of the optic nerve sheath. Acad Emerg Med 10(4):376-81. ultrasound evaluation of blunt abdominal trauma: program	1997	Sierzenski, PR. Thomas B, Falcone RE,	117	6	174
50	implementation, initial experience, and learning curve. J Trauma 42(3):384-8 A prospective trial of computed tomography and ultrasonography	2000	Vasquez D, et al. Horton MD, Counter SF,	115	7.5	249
51	for diagnosing appendicitis in the atypical patient. Am J Surg 179(5):379-81. Usefulness and limitations of ultrasonography in the initial	1998	Florence MG, et al. Yoshii H, Sato M,	115	6.1	150
52	evaluation of blunt abdominal trauma. J Trauma 45(1):45-50 Acute appendicitis: MR imaging and sonographic correlation.	1997	Yamamoto S, et al. Incesu L, Coskun A,	113	6.2	174
53	AJR. American journal of roentgenology 168(3), 669-674. Emergency department sonographic measurement of optic nerve	2007	Selcuk MB, et al. Tayal VS, Neulander M,	111	12.3	206
54	sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 49(4):508-14. Bedside echocardiography by emergency physicians.	2001	Norton HJ, et al. Mandavia DP, Hoffner RJ,	109	7.3	176
55	Ann Emerg Med 38(4):377-82. randomized controlled clinical trial of point-of-care, limited	2006	Mahaney K, et al. Melniker LA, Leibner E,	107	10.7	183
56	ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med 48(3):227-35. Diagnostic accuracy of ultrasound above and below the	1999	McKenney MG, et al. Barnhart KT, Simhan H,	106	6.4	108
57	beta-hCG discriminatory zone. Obstetrics & Gynecology 94(4), 583-587. Ultrasound based key clinical pathway reduces the use of	1997	Kamelle SA Branney SW, Moore EE,	105	5.9	124
58	Hospital resources for the evaluation of blunt abdominal trauma. J Trauma 42(6):1086-90. Rapid detection of pneumothorax by ultrasonography in patients	2006	Cantrill SV, et al. Zhang M, Liu ZH, Yang JX,	104	10.4	179
59	with multiple trauma. Crit Care 10(4):R112. The value of physical examination in the diagnosis of patients with	1997	Gan JX, et al. Schurink GW, Bode PJ,	104	5.5	161
60	blunt abdominal trauma: a retrospective study. Injury 28(4), 261-265. Sonographic measurement of the inferior vena cava as a marker	2005	van Luijt PA, et al. Lyon, M, Fvas M, Brannam, L.	101	9.2	153

Table 1 (continued)

Number	ARTICLE	Year	Authors	Scopus (total cite)	Citations per year	Google (total cite)
61	of blood loss. Am J Emerg Med 23(1):45-50. Serial 2-point ultrasonography plus D-dimer vs whole-leg	2008	Bernardi E, Camporese G,	100	12.5	154
	color-coded Doppler ultrasonography for diagnosing suspected		Buller HR et al.
62	symptomatic deep vein thrombosis: A randomized controlled trial. JAMA 8;300(14):1653-9 Use of ultrasonography in the patient with acute abdominal trauma.	1997	McGahan JP, Rose J,	100	5.3	144
63	J Ultrasound Med 16(10):653-62 Real-time ultrasound-guided Femoral Vein Catheterization During	1997	Coates TL, et al. Hilty WM, Hudson PA,	100	5.1	122
64	Cardiopulmonary Resuscitation. Ann Emerg Med 29(3):331-6 The role of surgeon-performed ultrasound in patients with possible	1996	Levitt MA, et al. Rozycki GS, Feliciano DV,	100	5.9	140
65	cardiac wounds. Ann Surg. 1996 Jun.;223(6):737-44 Imaging evaluation of suspected appendicitis in a pediatric population:	2000	Schmidt JA, et al. Sivit CJ, Applegate KE,	98	6.1	134
66	effectiveness of sonography versus CT. AJR Am J Roentgenol 175(4):977-80. Emergency department ultrasound scanning for Abdominal aortic aneurysm:	2000	Stallion A, et al. Kuhn M, Bonnin RL,	98	6.4	160
67	accessible, accurate, and advantageous. Ann Emerg Med 36(3):219-23. Hypotension after blunt abdominal trauma: the role of emergent	1996	Davey MJ, et al. Wherrett LJ, Boulanger BR,	98	4.9	159
68	abdominal sonography in surgical triage. J Trauma 41(5):815-20. Ectopic pregnancy: prospective study with improved diagnostic accuracy.	1996	McLellan BA, et al. Kaplan BC, Dart RG,	98	4.9	157
69	Ann Emerg Med 28(1):10-7. Sonographic screening of mass casualties for abdominal and renal	1991	Moskos M, et al. Sarkisian AE, Khondkarian RA,	96	4.6	110
70	injuries following the 1988 Armenian earthquake. J trauma 31(2), 247-250. Emergency department ultrasound in the evaluation of blunt abdominal	1993	Amirbekian NM, et al. Jehle, D, Guarino J,	96	4.2	143
71	trauma. Am J Emerg Med 11(4):342-6. Using clinical evaluation and lung scan to rule out suspected pulmonary	2000	Karamanoukian H. Perrier A, Miron MJ,	95	5.5	148
	embolism: is it a valid option in patients with normal results of lower-limb venous compression ultrasonography?		Desmarais S, et al.
72	Arch Intern Med 28;160(4):512-6. Prehospital Ultrasound imaging improves management of abdominal	2006	Walcher F, Weinlich M,	94	9.4	161
73	trauma. Br J Surg 93(2):238-42. Emergency echocardiography to detect pericardial effusion in patients	2003	Conrad G, et al. Tayal VS, Kline JA.	93	6.2	189
74	in PEA and near-PEA states. Resuscitation 59(3), 315-318. Ultrasonography for the evaluation of hemoperitoneum during	1994	Huang MS, Liu M, Wu JK, et al.	93	4.2	125
75	resuscitation: A simple scoring system. J Trauma 36(2):173-7 Sonography compared with radiography in revealing acute rib	1999	Griffith JF, Rainer TH,	92	5.4	137
76	fracture. AJR Am J Roentgenol 173(6):1603-9 Trauma ultrasound examination versus chest radiography in the	1997	Ching AS, et al. Ma OJ, Mateer JR.	91	4.7	158
77	detection of hemothorax. Ann Emerg Med 29(3):312-5 suspected ureteral colic: primary helical CT versus selective helical	2002	Catalano O, Nunziata A,	89	6.4	147
78	CT after unenhanced radiography and sonography. AJR Am J Roentgenol 178(2):379-87. Can cardiac sonography and capnography be used independently	2001	Altei F, Siani A. Salen P, O’Connor R, Sierzenski P,	89	5.9	111
	and in combination to predict resuscitation outcomes?		Passarello B, et al.
79	Acad Emerg Med 8(6):610-5. A study of bedside Ocular ultrasonography in the emergency	2002	Blaivas M, Theodoro D,	88	7.5	217
80	department. Acad Emerg Med 9(8):791-9. A prospective study of ultrasonography in the ED by emergency	1994	Sierzenski PR. Schlager D, Lazzareschi G,	87	4.0	136
81	physicians. Am J Emerg Med 12(2):185-9. Rapid detection of traumatic effusion using surgeon-performed	1998	Whitten D, et al. Sisley AC, Rozycki GS,	87	4.8	168
82	ultrasonography. J Trauma 44(2):291-6 Does the presence or absence of sonographically identified cardiac	2005	Ballard RB, et al. Salen P, Melniker L,	86	7.8	123
83	activity predict resuscitation outcomes of cardiac arrest patients? Am J Emerg Med 23(4):459-62 Emergency department bedside ultrasonographic measurement of	2010	Chooljian C, et al. Nagdev AD, Merchant RC,	84	14.4	251
84	the Caval index for noninvasive determination of low central venous pressure. Ann Emerg Med 55(3):290-5 Emergency thoracic ultrasound in the Differentiation of the Etiology	2009	Tirado-Gonzalez A, et al. Liteplo AS, Marill KA,	84	9	207
	of Shortness of Breath (ETUDES): Sonographic B-lines and N-terminal		Villen T, et al.
85	Pro-brain-type Natriuretic Peptide in Diagnosing Congestive Heart Failure. Acad Emerg Med 16(3):201-10. Acute appendicitis in children: comparison of clinical diagnosis with	2000	Karakas SP, Guelfguat M,	83	5.7	169
86	ultrasound and CT imaging. Pediatr Radiol. 30(2):94-8. The effect of soft-tissue ultrasound on the management of cellulitis in	2006	Leonidas JC, et al. Tayal VS, Hasan N,	82	8.2	130
87	the emergency department. Acad Emerg Med 13(4):384-8. Sonography as the primary screening technique for blunt abdominal	1998	Norton HJ, et al. McKenney KL, Nunez Jr. DB,	82	3.8	152
88	trauma: experience with 899 patients. AJR Am J Roentgenol. 170(4):979-85. Lower Extremity Doppler for Deep Venous Thrombosis-Can Emergency	2000	McKenney MG, et al. Blaivas M, Lambert MJ,	81	5.1	126
	Physicians Be Accurate and Fast? Acad Emerg Med 7(2):120-6.		Harwood RA, et al.
89	Chest ultrasonography in lung contusion. Chest 130(2):533-8.	2006	Soldati G, Testa A, Silva FR, et al.	80	8	141
90 91	Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study. AJR Am J Roentgenol 181(5):1355-9. Chest ultrasonography for the diagnosis and monitoring of high-altitude	2003 2007	Poortman P, Lohle PN, Schoemaker CM, et al. Fagenholz PJ, Gutman JA,	80 79	6.2 8.7	142 110
92	pulmonary edema. Chest 131(4):1013-8. Focused echocardiographic evaluation in life support and peri-resuscitation	2010	Murray AF, et al. Breitkreutz R, Price S,	78	13	112
	of emergency patients: a prospective trial. Resuscitation 81(11):1527-33.		Steiger HV, et al.

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Number	ARTICLE	Year	Authors	Scopus (total cite)	Citations per year	Google (total cite)
93	ABSCESS: applied Bedside sonography for convenient evaluation of superficial	2005	Squire BT, Fox JC, Anderson C.	78	7.1	122
94	soft tissue infections. Acad Emerg Med 12(7):601-6. emergency nurses‘ Utilization of Ultrasound Guidance for Placement of	2004	Brannam L, Blaivas M,	77	6.2	153
95	Peripheral Intravenous Lines in Difficult-access Patients. Acad Emerg Med 11(12):1361-3. Comparative assessment of CT and sonographic techniques for	2001	Lyon M, et al. Wise SW, Labuski MR,	77	5.3	153
96	appendiceal imaging. AJR Am J Roentgenol 176(4):933-41. Prospective evidence of the superiority of a sonography-based	1999	Kasales CJ, et al. Boulanger BR, McLellan BA,	76	4.5	123
97	algorithm in the assessment of blunt Abdominal injury. J Trauma 47(4):632-7. Bedside ultrasound of the lung for the monitoring of acute decompensated	2008	Brenneman FD, et al. Volpicelli G, Caramello V,	75	9.4	100
98	heart failure. Am J Emerg Med 26(5):585-91. Use of ultrasonography for the diagnosis of testicular injuries in blunt	2006	Cardinale L, et al. Buckley JC, McAninch JW	75	9	267
99	Scrotal trauma. J Urol 175(1):175-8 Prospective study of accuracy and outcome of emergency ultrasound	2003	Tayal VS, Graf CD, Gibbs MA.	75	5.8	107
100	for abdominal aortic aneurysm over two years. Acad Emerg Med 10(8):867-71 An algorithm to reduce the incidence of false-negative FAST examinations	1999	Ballard RB, Rozycki GS,	75	4.4	102
	in patients at high risk for occult injury. J Am Coll Surg 189(2):145-50		Newman PG, et al.

* The Journal of Trauma Injury Infection and Critical Care (J Trauma) has continued by Journal of Trauna and Acute Care Surgery since 2011.

?? Archives of Internal Medicine (Arch Intern Med)has continued by JAMA Internal Medicine since 2012.

determine the 100 most-cited studies that best matched the inclusion criteria. In cases of disagreement between the specialists, a third special- ist conducted an evaluation and rendered the deciding alternative. The chosen articles were sorted according to the number of citations as re- ported by Scopus. The annual citation rate was calculated by dividing the total number of citations by the number of years since publication (ci- tations per year = total number of citations/[2016-Publication year]). The number of citations obtained from each study was also evaluated using the Google Scholar database in addition to the Scopus data base.

Studies were modified using the methods of Lim et al. and evaluated by two independent emergency medicine specialists [5]. randomized controlled studies, case series, and cohort studies were included. The primary authors’ areas of specialty were determined based on affilia- tion, as reported in the journal. The number of patients evaluated in each study and the countries in which the studies were conducted (the primary author’s country was used in international studies) were determined and recorded. Those performing the USs were classified as

(1) emergency physician, (2) surgeon, (3) radiologist, (4) other (nurse, technician, etc.), or (5) not applicable (N/A). Using categories from the Web of Science (WOS), the journals in which the articles were published were classified as (1) surgery, (2) emergency medicine,

(3) radiology, or (4) other. Publication dates were classified as (1) prior to

1990, (2) 1990 to 1994, (3) 1995 to 1999, (4) 2000 to 2004, (5) 2005 to

2009, or (6) 2010 or later. The numbers of patients were classified as

(1) less than 100, (2) 101 to 500, (3) 501 to 1000, or (4) more than 1000. Ethical approval was obtained from the Ethics Committee of the

Dokuz Eylul University School of Medicine.

Data were evaluated online and recorded on study data forms. Sta- tistical analysis was performed using SPSS 15.0 for Windows. Categori- cal variables were described using numbers and percentages, whereas continuous variables were described using median and range. Numeri- cal variables between two independent groups were compared using the Student t test, whereas categorical variables were compared using the chi-square test. Multivariate groups were compared using analysis of variance. Statistical significance was recognized when P b .05.

Results

The 100 most-cited clinical studies on US in emergency departments are listed in rank order in Table 1. Published between 1988 and 2010, 85 were of prospective cohort design, 9 were randomized controlled stud- ies, and 6 were retrospective studies. All were written in English and published in one of 21 journals, 35 in emergency medicine journals,

34 in surgical journals, 14 in radiology journals, and 5 in critical care journals. Those journals that published more than five articles is given in Table 2. The median number of authors was 6 (range, 1-21).

Using Scopus to determine the number of citations, the median was 115 (range, 75-681), but using Google Scholar, the median was 170.5 (range, 100-877). The difference between them was significant (P b .001). The most-cited study in all three categories was described by Perrier et al. in “Non-invasive diagnosis of venous thromboembolism in outpatients.”.

Using the annual citation rate to determine the top 10 articles, 5 were published in emergency medicine journals. Three were on the topic of lung US, 2 were regarding interventional US, 2 were on the vas- cular US and the remainder involved FAST exams, Inferior vena cava and optic nerve US. Three were randomized controlled studies, and 7 were prospective cohort studies.

In all, 37,211 patients were studied (median per study, 214.5; range, 11-2676). There was no difference between the number of patients evaluated in the studies and total citations (P = .103; Table 3).

The primary authors were most commonly emergency physicians (46%) and surgeons (32%). The most commonly researched areas were FAST and abdominal US (32% and 13%, respectively). There was no sig- nificant relationship between US area and number of citations, per Scopus (P = .472). However, there was a significant difference when the annual citation rate was used (P = .025). Vascular US studies had the greatest median annual citation rate (12.5; range, 5.1-40.1). The people performing the USs were most commonly emergency physicians

(37) and radiologists (20); however, we could not obtain this informa- tion in 6 studies.

The subjects of the studies according to primary author affiliation are presented in Table 2. Emergency physicians conducted studies on a va- riety of subjects, while surgeons and radiologists studied mostly FAST and abdominal USs (Fig. 1).

Table 2

Journals with more than five published articles from the 100 most-cited clinical studies on ultrasound in the emergency department

Journal title	Number of articles
Journal of Trauma and Acute Care Surgery	27
Academic Emergency Medicine	16
Annals of Emergency Medicine	11
American Journal of Roentgenology	8
American Journal of Emergency Medicine	6

Table 3

Properties of the 100 most-cited studies on ultrasound conducted in the emergency department

	Subgroup	N	Total citations Median(range)	Annual citations Median (range)	Total citations P value	Annual citations P value
Sample size	<= 100	25	100 (75-185)	7.5 (4.2-14.4)	0.103	0.51
	101-500	54	118 (75-254)	7.4 (3.8-20.4)
	501-1000	11	124 (76-681)	8.2 (4.5-40.1)
	N 1000	10	125.5(75-223)	6.0 (4.4-12.5)
	Total	100	115 (75-681)	7.5 (3.8-40.1)
Year of publication	b 1990	1	120	4.3	0.330	0.005*
	1990-1994	15	130 (87-254)	5.9 (4-11)
	1995-1999	32	116 (75-681)	6.2 (4.0-40.1)
	2000-2004	29	109 (75-226)	7.5 (4.7-18.8)
	2005-2009	21	104 (75-206)	10.5 (3.8-25.5)
	>= 2010	2	78-84	132.0-14.4
USG area	FAST	32	124.5 (75-254)	7.2 (4.2-8.8)	0.472	0.025*
	Abdomen (non trauma)	13	120 (77-222)	6.1 (4.3-11.9)
	Cardiac	11	100 (75-157)	8.7 (4.8-13)
	Lung	10	97.5 (79-206)	9.7 (4.0-20.4)
	Vascular	8	129 (75-681)	12.5 (5.1-40.1)
	Invasive	7	120 (77-156)	8,1 (5.3-14.2)
	Optic nerve	4	114 (88-119)	11.2 (7.5-12.3)
	Urogenital	4	105.5 (75-146)	7.4 (4.7-9.3)
	Goal directed	3	103.5 (87-120)	4.6 (4-5.2)
	Obstetric	3	106 (98-130)	6,4 (5.9-6.4)
	IVC	2	87-120	9.2-14.4
	Soft tissue	2	78-82	3.8-7.1
	Bone	1	92	5.4
Country	USA	69	109 (75-254)	7.5 (3.8-18.7)	0.156	0.210
	Non USA articles	31	123 (75-691)	7.2 (4.2-40.0)
	Italy	8
	Switzerland	5
	Canada, Holland	3
	Germany, China, Japan	2
	Australia, Armenia, Israel, Sweden, Taiwan, Turkey	1
First author’s affiliation	Emergency Medicine	46
	Surgery	32
	Radiology	15
	Internal medicine	3
	Gynecology & Obstetrics	2
	Urology, intensive care	1
USG performer	Emergency physician	37
	Surgeon	20
	Radiology	24
	Other (nurse, technicians etc.)	7
	Multiple performer	6
	N/A	6

Abbreviation: USG, ultrasonogram.

The authors were from 14 countries, primarily the USA (69) and Italy

(8). There was no significant relationship between whether a study was completed in the USA and the total or average number of citations (P =

.156 and P = .210). While there was no significant difference between the number of citations in randomized controlled (RCT) studies and other (NRT) studies (RCT: 136.0 +- 11.9, NRT: 129.7 +- 7.7; P = .789),

Fig. 1. Ultrasound Fields of study based on the primary authors’ specialties.

the median annual citation rate was higher among the RCTs (RCT: 12.7 +- 2.4, NRT: 8.4 +- 0.5; P = .013).

Discussion

The number of times a scientific paper is cited in other publications is an approximate measure of the impact of the work in that field. We eval- uated this property for highly-cited studies on ultrasonography in emer- gency medicine; however, because older articles often have a greater number of total citations, the annual citation rate was also studied.

In 2006 and 2015, the most-cited studies in emergency medicine were evaluated [3,4]. In these studies, the 100 most-cited studies in emergency medicine were evaluated over two time periods. In one study investigating the most-cited publications on imaging in trauma patients, Dolan et al. were excluded studies where the evaluator of the images was not a radiologist [6]. No previous Bibliometric study has evaluated emergency medicine subspecialty fields. This is the first bibliometric study conducted in a subspeciality of emergency medicine. Scopus, Google Scholar, or WOS can be used to determine how often an article has been cited so that bibliographic studies can be performed. Because non-English articles are included in Scopus, it has a wider range of citations than WOS [7]. For this reason, the 100 most-cited articles were determined based on data provided by Scopus. However, in deter- mining the number of citations, including only articles published in medical journals may not be adequate in reflecting current trends. Goo- gle Scholar is able to scan additional conference proceedings, and the WOS includes non-conventional citations in online documents, univer- sity theses, and web sites. Using Google Scholar, many researchers can expect 15% to 30% increases in their h-indicies over those obtained using Scopus and WOS. Google Scholar is a valid tool for Health Science researchers who calculate bibliometric indicators [8]. In this study, we aimed to determine the most-cited articles in the ultrasonography field of emergency medicine and to identify current areas of interest. These parameters can also be used to determine the most popular arti- cles on any topic. For this reason, we evaluated the total number of cita-

tions, as obtained from Google Scholar, separately.

Almost half of the 100 most-cited ultrasonography studies in emer- gency medicine were conducted by emergency physicians. In 79% of those authored primarily by emergency physicians, the US images were obtained by emergency physicians. The other studies conducted by emergency physicians included a wider range of fields when com- pared to other specialties. The ultrasonographic imaging technique, which was first widespread among radiologists and specialists, is now performed widely by emergency physicians. Today, an emergency phy- sician is expected to safely and effectively perform ultrasonography for diagnosis and intervention [9]. “Emergency ultrasonography” defines diagnostic ultrasonographic imaging performed and evaluated by the emergency physician in the emergency department on the emergency patient [10]. We evaluated studies on ultrasonography in the emergen- cy department, including those that examined bedside US. In one-fourth of the 100 most-cited articles, US evaluation was performed by radiolo- gists. Many recent US studies were conducted by clinicians, and that most imaging US users are non-radiologists is itself remarkable.

With the development of portable technologies, US has become

widespread among clinicians in many fields for spot diagnosis, and the use of this technique is increasing [11]. Ultrasound is becoming a rou- tine part of the clinical examination and has recently been referred to as the “stethoscope of the future” [12]. Point of Care Ultrasound (POCUS) is defined as bedside ultrasonographical imaging performed and interpreted by the clinician [13]. Of the 12 areas of focus found in highly-cited studies on US, we found that FAST and abdominal US were the most common, and this was not surprising because emergency

ultrasonographical imaging was typically used in trauma and investiga- tional studies. However, when ranked by annual citation rate, the areas of focus were different. Most of the highly-cited studies conducted after 2000 concentrated on POCUS. Vascular, thoracic, and optic nerve sheath diameter studies were among those with the greatest average citation rate.

In the emergency department, 36% of the most-cited US studies were conducted to evaluate intra-abdominal and intrathoracic patholo- gies in trauma patients. Dolan et al. evaluated the 100 most-cited stud- ies on imaging in trauma, and only one article in our set of most-cited studies was also in their set of studies (“Abdominal ultrasound as a reli- able indicator for conclusive laparotomy in blunt abdominal trauma” by Bode et al. and published in The Journal of Trauma, Vol. 34, pp. 27-31). In addition, they identified only 2 studies using US [6], whereas US stud- ies on trauma patients were popular. We found that 3 of the 10 most- cited articles described studies evaluating pneumothorax in trauma.

Limitations

Like all bibliometric studies, this study has many limitations. First, Scopus was used to search for the most-cited articles. The number of ci- tations is known to differ between databases [7]. The studies were eval- uated based on the number of citations and mean annual citation rate, but not sorted accordingly. Finally, although the number of citations and mean annual citation rate are traditional parameters for evaluating the scientific value of an article, its contribution to science cannot be evaluated by these measures alone.

Conclusion

The most-cited articles on ultrasonography addressed either FAST or abdominal US. Vascular and lung US studies received the most citations per year. Many physicians from a wide range of specialties conducted studies in this area, and approximately half of the primary authors of the most-cited studies were emergency physicians.

References

AJEM

Bibliometric analysis of top 100 most-cited clinical studies on ultrasound in the Emergency Department

a b s t r a c t

Introduction

Method

Results

Discussion

Limitations

Conclusion

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Bibliometric analysis of top 100 most-cited clinical studies on ultrasound in the Emergency Department

a b s t r a c t

Introduction

Method

Results

Discussion

Limitations

Conclusion

Leave a Reply Cancel reply

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