Uncategorized

A 10-year bibliometric analysis of publications in emergency medicine

a b s t r a c t

Objective: Emergency medicine (EM) research is growing at a rapid pace. It is important to understand the scope and trends over time in order to identify gaps and future areas for growth. This study aimed to describe trends in Scientific publications within EM over the past decade.

Methods: We searched the Web of Science database’s Emergency Medicine category for all scientific publications

published between 2010 and 2019. Data were presented via descriptive statistics. Inferential bibliometric analy- ses included clustering of the selected parameters of keywords, Keyword Plus, titles, and abstracts; Bradford’s law to evaluate core journals, and the Sankey diagrams to evaluate the flows between research themes over time. Results: We identified 32,858 articles written by 85,693 authors. The mean citations per document were 11. The top five countries with the highest number of publications were the United States (n = 42,221), Turkey (n = 6595), Canada (n = 6545), Australia (n = 5867), and China (n = 5322). The journals with the highest number of publications: the American Journal of Emergency Medicine, Journal of Emergency Medicine, Resuscitation, and Pediatric Emergency Care. The most frequent topics were Cardiovascular emergencies, resuscitation, mortality, patient outcomes, emergency imaging, triage, education, and management.

Conclusion: This bibliometric study is a quick snapshot of research in the EM field in the last decade and may provide insights into the scientific agendas of the EM professionals.

Introduction

Emergency Medicine (EM) is a relatively younger discipline, having been officially recognized as a separate and unique specialty by the American Board of medical specialties in 1979 [1,2]. Since that time, there has been substantial growth in the EM literature. As of January 2022, the Web of Science EM Category includes 141,000 records, of which 21% were between 1967 and 2000, and 79% were published in the last two decades [3]. However, as the field has grown, it has become increasingly important to understand the current architecture of the lit- erature and to identify recent trends in scientific publications. Knowl- edge of this can inform our understanding of which topics have garnered larger amount of research attention, comparisons with other specialties, and future research agendas. This study sought to describe the bibliometric characteristics of scientific research within EM over the last decade.

* Corresponding author.

E-mail address: [email protected] (M. Cetin).

Methods

This was a retrospective study of original research publications within EM over a 10-year period. We utilized Clarivate Analytics’ Web of Science (WOS) database [3]. This database includes scientific articles since 1900, comprises over 171 million records, and has 1.9 billion cited references across disciplines [4]. The WOS also allows subcategorization by Research Field, including EM.

After screening for the EM category, we limited our search to January

1, 2010 - December, 31, 2019. Then we limited the dataset to only the “research article” document type (n = 41,142) and English language ar- ticles to maintain uniformity in the dataset (n = 32,858).

The bibliometric analyses included descriptive data of the primary publication characteristics such as the number of authors, number of ci- tations, country of origin of the coauthors, and journal name. We per- formed cluster analyses of Keyword Plus (as defined by the Clarivate

[5]:”words or phrases that frequently appear in the titles of an article’s ref-

erences, but do not appear in the title of the article itself“), keywords, and titles based on the recurrence of the words used and their co-occurrence to form a cluster. We then performed inferential analyses including Brafford’s Law [6] to identify the core cluster of journals with the highest number of publications, followed by Sankey diagrams to evaluate the

https://doi.org/10.1016/j.ajem.2022.06.016

Image of Fig. 1

Fig. 1. Publication during the study period.

flow between research themes over time. We subsequently created a word cloud matrix and a thematic map to present the bibliometric char- acteristics of the data. The thematic map included motor, niche, emerg- ing or declining, and basic themes [7]. Motor themes resembled the most intensely studied themes, which are also connected with other themes. Niche themes included the research fields that are only inter- nally connected and had weak connections with others. Basic themes refer to essential but not much studied themes, and and emerging/ declining themes are the foundational fields, or fields becoming more or less popular during the relevant timespan, respectively [13]. The sta- tistical analyses were conducted using the Bibliometrix package in R on

R-Studio Server [7] running on a Compute Engine VM infrastructure of Google Cloud Platform.

Results

A total of 32,858 articles were included in the analyses. The total number of authors in the manuscripts was 85,693, and 1206 manu- scripts were published by a single author. Total publications per year in- creased from 2584 in 2010 to 3529 in 2019. The mean citations per

document were 11.7 +- 4.7 (range: 0-884) (Fig. 1).

Image of Fig. 2

Fig. 2. Country ranking for the total number of publications and citations in the WOS EM category between 2010 and 2019.

Image of Fig. 3

Fig. 3. Bradford’s Law.

The top five countries with the largest number of authors appeared in publications were the United States (n = 42,221), Turkey (n = 6595), Canada (n = 6545), Australia (n = 5867), and China (n = 5322). The top 20 countries with regard to the total number of publica- tions and citations are presented in Fig. 2.

The source journal metrics were evaluated using Bradford’s Law zones, indicating core journals in the category, and the h-index ranks showing their impact through citation counts. Accordingly, Zone 1 of Bradford’s Law included the American Jour- nal of Emergency Medicine, Journal of Emergency Medicine, Resusci- tation, and Pediatric Emergency Care journals, which published 35.9% of the total publications between 2010 and 2019 (Fig. 3). However, the ranking in Bradford’s Law was changed significantly when the h-index was considered. The journal Resuscitation from zone 1 was the most cited journal, followed by Annals of Emer- gency Medicine (zone 2, rank 9), Academic Emergency Medicine (zone 2, rank 6), and Injury (zone 2, rank 5) (Table 1). The 100 Top-cited articles published in these journals during the last decade are presented in Table 2.

The most frequently used words in the keywords and article titles were considered to reflect the general scopes of the articles. The analy- ses of Keyword Plus showed that the most frequent words were “man- agement”, “care”, and “mortality” among the full cohort and “hospital cardiac arrest”, “cardiopulmonary resuscitation”, and “care” in the 100 top-cited articles. The most frequent author keywords were “emer- gency department”, “cardiac arrest”, and “trauma” and “cardiac arrest”, “resuscitation”, and “cardiopulmonary resuscitation” for the full cohort and 100 top-cited, respectively. (Supplementary Appendix - Table 1). The word cloud matrix is presented in Fig. 4, and the trend topics deter- mined by the Keyword Plus, author keywords, and article titles between 2010 and 2019 are presented in Supplementary Appendix - Table 2.

The thematic map determined by the authors’ keywords is pre- sented in Fig. 5. The analyses revealed that the top five niche themes were emergency medicine, emergency medical services, education, pre- hospital, and simulation. There were two motor theme clusters, which the first included emergency department, triage, pediatrics, emergency service, and hospital. The second cluster in motor themes covered trauma, mortality, epidemiology, injury, and pediatrics. The top five basic themes in the articles were ultrasound, emergency, computed to- mography, ultrasonography, and diagnosis. And there were two clusters in emerging or declining themes, the emerging cluster included sepsis, and the declining cluster included cardiac arrest, cardiopulmonary re- suscitation, resuscitation, out-of-hospital cardiac arrest, and outcome.

Discussion

Bibliometric analyses are practical and reliable methods to infer the scientific or academic performance or productivity on a predetermined topic or period [8]. We identified 32,858 articles by 85,693 authors which demonstrated an overall increasing trend that peaked in 2015. This demonstrates an impressive growth in the total number of EM orig- inal literature publications over this initial time period and subsequent stabilization over the past five years.

An overwhelming proportion of publications were from the United States, followed by Turkey, Canada, Australia, China, and the United Kingdom. This might be related to several factors, including the time of establishing EM as a separate discipline in different countries, funding for research, heavy workload interfering with academic productivity, etc. Although there is no evidence regarding the reasons for the differ- ence in the academic productivity between countries, a previous com- mentary on the declining EM publications in the United Kingdom

Table 1

Bradford’s Law Zones and Top 20 journals with the highest number of publications, citations, and h-index

Bradford’s Law Zone Journals	Articles			Citations
	N	Cumulative N	Rank	Total citations	h-index	Rank
American Journal of Emergency Medicine	4221	4221	1	38,964	55	5
Zone 1 Journal of Emergency Medicine	3124	7345	2	26,664	52	6
35.9% of total publications Resuscitation	2481	9826	3	75,347	98	1
Pediatric Emergency Care	1968	11,794	4	15,545	41	9
Injury-International Journal of the Care of the Injured	1695	13,489	5	27,177	59	4
Academic Emergency Medicine	1624	15,113	6	34,704	72	3
Emergency Medicine Journal	1429	16,542	7	19,164	48	7
Zone 2 Western Journal of Emergency Medicine	1184	17,726	8	11,767	38	10
32% of total publications Annals of Emergency Medicine	1161	18,887	9	35,249	80	2
Turkish Journal of Trauma & Emergency Surgery	886	19,773	10	4484	21	19
Prehospital and Disaster Medicine	861	20,634	11	6970	31	11
Emergency Medicine Australasia	843	21,477	12	7231	30	13
Scandinavian Journal of Trauma Resuscitation & Emergency Medicine	824	22,301	13	11,901	43	8
European Journal of Trauma and Emergency Surgery	759	23,060	14	5304	25	17
European Journal of Emergency Medicine	687	23,747	15	6495	31	12
Zone 3 Journal of Emergency Nursing	654	24,401	16	5492	30	14
32.1% of total publications Canadian Journal of Emergency Medicine	616	25,017	17	4758	28	15
Hong Kong Journal of Emergency Medicine	569	25,586	18	970	10	20
Emergency Medicine Clinics of North America	511	26,097	19	5213	27	16
International Journal of Emergency Medicine	431	26,528	20	3757	25	18
All remaining journals	6330	32,858

Table 2

Top-cited 100 articles published between 2010 and 2019

Author(s)	Journal	Year	Article Title	Total Citations	TC perYear	Normalized TC
Soar, J., et al.	Resuscitation	2015	European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult	884	110.5	2.538
			advanced life support
Nolan, J.P., et al.	Resuscitation	2010	European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive	801	61.6	3.036
			summary
Marsell, R. and T.A.	Injury	2011	The biology of fracture healing	777	64.8	3.088
Einhorn. Deakin, C.D., et al.	Resuscitation	2010	European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult	749	57.6	2.839
			advanced life support
Perkins, G.D., et al.	Resuscitation	2015	European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult	683	85.4	1.961
			basic life support and Automated external defibrillation
Nolan, J.P., et al.	Resuscitation	2015	European Resuscitation Council and European Society of Intensive Care Medicine	637	79.6	1.829
			Guidelines for post-resuscitation care 2015: Section 5 of the European Resuscitation
			Council Guidelines for Resuscitation 2015
Monsieurs, K.G.,	Resuscitation	2015	European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive	596	74.5	1.711
et al.			summary
Truhlar, A., et al.	Resuscitation	2015	European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac	506	63.2	1.453
			arrest in special circumstances
Smith, G.B., et al.	Resuscitation	2013	The ability of the National Early Warning Score to discriminate patients at risk	430	43.0	1.760
			of early cardiac arrest, unanticipated intensive care unit admission, and death
Grasner, J.T., et al.	Resuscitation	2016	EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis	416	59.4	1.833
			of out-of-hospital Cardiac arrest outcomes in 27 countries in Europe
Koster, R.W., et al.	Resuscitation	2010	European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic	406	31.2	1.539
			life support and use of automated external defibrillators
Sun, B.C., et al.	Annals of Emergency	2013	Effect of emergency department crowding on outcomes of admitted patients	375	37.5	1.535
	Medicine
Soar, J., et al.	Resuscitation	2010	European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac	373	28.7	1.414
			arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, acci-
			dental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma,
			pregnancy, electrocution
Stub, D., et al.	Resuscitation	2015		349	43.6	1.002
			Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early
			reperfusion (the CHEER trial)
Pines, J.M., et al.	Academic Emergency	2011	International perspectives on emergency department crowding	343	28.6	1.363
	Medicine
Prytherch, D.R.,	Resuscitation	2010	ViEWS-Towards a national early warning score for detecting adult inpatient	323	24.8	1.224
et al.			deterioration
Jacobs, I.G., et al.	Resuscitation	2011	Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomized	306	25.5	1.216
			double-blind placebo-controlled trial
Hooper, C., et al.	Journal of Emergency	2010	Compassion satisfaction, burnout, and compassion fatigue among emergency nurses	298	22.9	1.130
	Nursing		compared with nurses in other selected inpatient specialties
Green, S.M., et al.	Annals of Emergency	2011	Clinical practice guideline for emergency department ketamine dissociative sedation:	297	24.8	1.180
	Medicine		2011 update
Singer, A.J., et al.	Academic Emergency	2011	The association between length of emergency department boarding and mortality	294	24.5	1.169
	Medicine
Wyllie, J., et al.	Resuscitation	2015	European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resusci-	291	36.4	0.835
			tation and support of transition of babies at birth
Perkins, G.D., et al.	Resuscitation	2015	Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the	288	36.0	0.827
			Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: A
			Statement for Healthcare Professionals From a Task Force of the International Liaison
			Committee on Resuscitation (American Heart Association, European Resuscitation
			Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foun-
			dation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern
			Africa, Resuscitation Council of Asia); and the American Heart Association Emergency
			Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care,
			Perioperative and Resuscitation
Sakamoto, T., et al.	Resuscitation	2014	extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary	287	31.9	1.470
			resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational
			study
Daya, M.R., et al.	Resuscitation	2015	Out-of-hospital Cardiac arrest survival improving over time: Results from the	285	35.6	0.818
			Resuscitation Outcomes Consortium (ROC)
Weingart, S.D. and	Annals of Emergency	2012	Preoxygenation and prevention of desaturation during Emergency airway management	283	25.7	1.526
R.M. Levitan.	Medicine
Perera, P., et al.	Emergency Medicine	2010	The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll	279	21.5	1.058
	Clinics of North
	America
Sakles, J.C., et al.	Academic Emergency	2013	The importance of First pass success when performing orotracheal intubation in the	274	27.4	1.122
	Medicine		emergency department
Maconochie, I.K.,	Resuscitation	2015	European Resuscitation Council Guidelines for Resuscitation 2015: Section 6. Pediatric	274	34.2	0.787
et al.			life support
Kocher, K.E., et al.	Annals of Emergency	2011	National trends in use of computed tomography in the emergency department	270	22.5	1.073
	Medicine
Breitkreutz, R.,	Resuscitation	2010	Focused echocardiographic evaluation in life support and peri-resuscitation of	260	20.0	0.986
et al.			emergency patients: a prospective trial
Hankenson, K.D.,	Injury	2011	Angiogenesis in bone regeneration	250	20.8	0.994
et al.

Author(s)	Journal	Year	Article Title	Total Citations	TC perYear	Normalized TC
Stoltzfus, J.C.	Academic Emergency	2011	Logistic regression: a brief primer	247	20.6	0.982
	Medicine
Calori, G.M., et al.	Injury	2011	The use of bone-graft substitutes in large bone defects: any specific needs?	243	20.2	0.966
Hak, D.J., et al.	Injury	2014	Delayed union and nonunions: epidemiology, clinical issues, and financial aspects	242	26.9	1.240
Garra, G., et al.	Academic Emergency	2010	Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency	240	18.5	0.910
	Medicine		department patients
Sandroni, C., et al.	Resuscitation	2014	Prognostication in comatose survivors of cardiac arrest: an advisory statement from the	239	26.6	1.224
			European Resuscitation Council and the European Society of Intensive Care Medicine
Nolan, J.P., et al.	Resuscitation	2014	Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National	236	26.2	1.209
			Cardiac Arrest Audit
DeVita, M.A., et al.	Resuscitation	2010	“Identifying the hospitalised patient in crisis”-a consensus conference on the afferent	232	17.8	0.879
			limb of rapid response systems
Hannink, G. and	Injury	2011	Bioresorbability, porosity and mechanical strength of bone substitutes: what is optimal	230	19.2	0.914
J.J.C. Arts.			for bone regeneration?
Greif, R., et al.	Resuscitation	2015	European Resuscitation Council Guidelines for Resuscitation 2015: Section 10. Educa-	230	28.8	0.660
			tion and implementation of resuscitation
Dragancea, I., et al.	Resuscitation	2013	The influence of induced hypothermia and delayed prognostication on the mode of	225	22.5	0.921
			death after cardiac arrest
Wiler, J.L., et al.	Annals of Emergency	2010	Optimizing emergency department front-end operations	224	17.2	0.849
	Medicine
Newgard, C.D.,	Annals of Emergency	2010	Emergency medical services intervals and survival in trauma: assessment of the	221	17.0	0.838
et al.	Medicine		“golden hour” in a North American prospective cohort
Biarent, D., et al.	Resuscitation	2010	European Resuscitation Council Guidelines for Resuscitation 2010 Section 6. Pediatric	220	16.9	0.834
			life support
Bossaert, L.L., et al.	Resuscitation	2015	European Resuscitation Council Guidelines for Resuscitation 2015: Section 11. The	215	26.9	0.617
			ethics of resuscitation and end-of-life decisions
Sproul, R.C., et al.	Injury	2011	A systematic review of locking plate fixation of Proximal humerus fractures	207	17.2	0.823
Mueller, C., et al.	Annals of Emergency	2016	Multicenter Evaluation of a 0-Hour/1-Hour Algorithm in the Diagnosis of Myocardial	203	29.0	0.894
	Medicine		Infarction With high-sensitivity cardiac troponin T
Floccard, B., et al.	Injury	2012	Early coagulopathy in trauma patients: an on-scene and hospital admission study	202	18.4	1.089
Wik, L., et al.	Resuscitation	2014	Manual vs. integrated automatic load-distributing band CPR with equal survival after	201	22.3	1.030
			out of hospital cardiac arrest. The randomized CIRC trial
Zimmermann, G.	Injury	2011	Allograft bone matrix versus synthetic bone graft substitutes	196	16.3	0.779
and A. Moghaddam.
Deakin, C.D., et al.	Resuscitation	2010	Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary	196	15.1	0.743
			Resuscitation and Emergency Cardiovascular Care Science with Treatment
			Recommendations
Papa, L., et al.	Annals of Emergency	2012	Elevated levels of serum glial fibrillary acidic protein breakdown products in mild and	193	17.5	1.041
	Medicine		moderate traumatic brain injury are associated with intracranial lesions and
			neurosurgical intervention
Lichte, P., et al.	Injury	2011	Scaffolds for bone healing: concepts, materials and evidence	191	15.9	0.759
Taylor, R.A., et al.	Academic Emergency	2016	Prediction of In-hospital Mortality in Emergency Department Patients With Sepsis: A	188	26.9	0.828
	Medicine		Local Big Data-Driven, machine learning Approach
Cheung, P.T., et al.	Annals of Emergency	2012	National study of barriers to timely primary care and emergency department utilization	185	16.8	0.998
	Medicine		among Medicaid beneficiaries
Wyllie, J., et al.	Resuscitation	2015	Part 7: Neonatal resuscitation: 2015 International Consensus on Cardiopulmonary	185	23.1	0.531
			Resuscitation and Emergency Cardiovascular Care Science with Treatment
			Recommendations
Flores, G., et al.	Annals of Emergency	2012	Errors of medical interpretation and their potential clinical consequences: a comparison	184	16.7	0.992
	Medicine		of professional versus ad hoc versus no interpreters
Krappinger, D.,	Injury	2011	Predicting failure after surgical fixation of proximal humerus fractures	184	15.3	0.731
et al. Rommens, P.M.	Injury	2013	Comprehensive classification of fragility fractures of the pelvic ring: Recommendations	182	18.2	0.745
and A. Hofmann.			for surgical treatment
Wilson, M.P., et al.	Western Journal of	2012	The psychopharmacology of agitation: consensus statement of the american association	182	16.5	0.981
	Emergency Medicine		for Emergency psychiatry project Beta psychopharmacology workgroup
Giannoudis, P.V.,	Injury	2011	Masquelet technique for the treatment of bone defects: tips-tricks and future directions	181	15.1	0.719
et al. Ong, M.E.H., et al.	Resuscitation	2015	Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia: The Pan Asian	179	22.4	0.514
			Resuscitation Outcomes Study (PAROS)
Nagdev, A.D., et al.	Annals of Emergency	2010	Emergency department bedside ultrasonographic measurement of the Caval index for	179	13.8	0.679
	Medicine		noninvasive determination of low central venous pressure
Vaillancourt, C.,	Resuscitation	2011	The impact of increased chest compression fraction on return of spontaneous	178	14.8	0.707
et al.			circulation for out-of-hospital cardiac arrest patients not in ventricular fibrillation
Soar, J., et al.	Resuscitation	2015	Part 4: Advanced life support: 2015 International Consensus on Cardiopulmonary	177	22.1	0.508
			Resuscitation and Emergency Cardiovascular Care Science with Treatment
			Recommendations
Vadeboncoeur, T.,	Resuscitation	2014	chest compression depth and survival in out-of-hospital cardiac arrest	176	19.6	0.902
et al. Cooper, S., et al.	Resuscitation	2010	Rating medical emergency teamwork performance: development of the Team	176	13.5	0.667
			Emergency Assessment Measure (TEAM)
Kragh, J.F., et al.	Journal of Emergency	2011	Battle casualty survival with emergency tourniquet use to stop limb bleeding	172	14.3	0.684
	Medicine

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Author(s)	Journal	Year	Article Title	Total Citations	TC perYear	Normalized TC
Pitts, S.R., et al.	Annals of Emergency	2012	National trends in emergency department occupancy, 2001 to 2008: effect of inpatient	171	15.5	0.922
	Medicine		admissions versus emergency department practice intensity
Brown, C.A., et al.	Annals of Emergency	2015	Techniques, success, and adverse events of emergency department adult intubations	170	21.2	0.488
	Medicine
Nolan, J.P., et al.	Resuscitation	2010	Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary	169	13.0	0.641
			Resuscitation and Emergency Cardiovascular Care Science With Treatment
			Recommendations
Richmond, J.S.,	Western Journal of	2012	Verbal De-escalation of the Agitated Patient: Consensus Statement of the American	165	15.0	0.890
et al.	Emergency Medicine		Association for Emergency Psychiatry Project BETA De-escalation Workgroup
Osterhoff, G., et al.	Injury	2016	Bone mechanical properties and changes with osteoporosis	164	23.4	0.722
Elmer, J., et al.	Resuscitation	2016	Association of early withdrawal of life-sustaining therapy for perceived neurological	164	23.4	0.722
			prognosis with mortality after cardiac arrest
Harmsen, A.M.K.,	Injury	2015	The influence of prehospital time on trauma patients outcome: a systematic review	163	20.4	0.468
et al. Kagawa, E., et al.	Resuscitation	2010	Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest	163	12.5	0.618
			patients treated with cardiopulmonary resuscitation using Extracorporeal life support
Pope, J.V., et al.	Annals of Emergency	2010	Multicenter study of Central venous oxygen saturation (ScvO(2)) as a predictor of	163	12.5	0.618
	Medicine		mortality in patients with sepsis
Newman-Toker,	Academic Emergency	2013	HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and	160	16.0	0.655
D.E., et al.	Medicine		dizziness
Hasegawa, K.,	Annals of Emergency	2012	Association between repeated intubation attempts and adverse events in emergency	160	14.5	0.863
et al.	Medicine		departments: an analysis of a Multicenter prospective observational study
Al Deeb, M., et al.	Academic Emergency	2014	Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema	159	17.7	0.815
	Medicine		in patients presenting with acute dyspnea: a systematic review and meta-analysis
Cantrill, S.V., et al.	Annals of Emergency	2012	Clinical policy: critical issues in the prescribing of opioids for adult patients in the	159	14.5	0.857
	Medicine		emergency department
Stafford, P.R. and	Injury	2010	Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone	159	12.2	0.603
B.L. Norris.			defect nonunions: a review of 25 cases
Carpenter, C.R.,	Academic Emergency	2011	Evidence-based diagnostics: adult Septic arthritis	158	13.2	0.628
et al.	Medicine
Perkins, G.D., et al.	Resuscitation	2015	Part 3: Adult basic life support and automated external defibrillation: 2015	158	19.8	0.454
			International Consensus on Cardiopulmonary Resuscitation and Emergency
			Cardiovascular Care Science with Treatment Recommendations
Schneir, A.B., J.	Journal of Emergency	2011	“Spice” girls: Synthetic cannabinoid intoxication	157	13.1	0.624
Cullen, and B.T.	Medicine
Ly.
Han, J.H., et al.	Annals of Emergency	2013	Diagnosing delirium in older emergency department patients: validity and reliability of	156	15.6	0.639
	Medicine		the delirium triage screen and the brief confusion assessment method
Doupe, M.B., et al.	Annals of Emergency	2012	frequent users of emergency departments: developing standard definitions and	156	14.2	0.841
	Medicine		defining prominent risk factors
Wilkerson, R.G.	Academic Emergency	2010	Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the	156	12.0	0.591
and M.B. Stone.	Medicine		identification of pneumothorax after blunt trauma
Zijlstra, J.A., et al.	Resuscitation	2014	Local lay rescuers with AEDs, alerted by text messages, contribute to Early defibrillation	155	17.2	0.794
			in a Dutch out-of-hospital cardiac arrest dispatch system
Horwitz, L.I., J.	Annals of Emergency	2010	US emergency department performance on wait time and length of visit	155	11.9	0.588
Green, and E.H.	Medicine
Bradley.
Rea, T.D., et al.	Annals of Emergency	2010	Predicting survival after out-of-hospital cardiac arrest: role of the Utstein data elements	154	11.8	0.584
	Medicine
Godwin, S.A., et al.	Annals of Emergency	2014	Clinical policy: Procedural sedation and analgesia in the emergency department	153	17.0	0.784
	Medicine
Self, W.H., et al.	American Journal of	2013	High discordance of chest x-ray and computed tomography for detection of pulmonary	152	15.2	0.622
	Emergency Medicine		opacities in ED patients: implications for diagnosing pneumonia
Veronese, N. and S.	Injury	2018	Epidemiology and social costs of Hip fracture	151	30.2	1.000
Maggi. Hollenbeck, R.D.,	Resuscitation	2014	Early cardiac catheterization is associated with improved survival in comatose	151	16.8	0.774
et al.			survivors of cardiac arrest without STEMI
Walls, R.M., et al.	Journal of Emergency	2011	Emergency airway management: a multi-center report of 8937 emergency department	151	12.6	0.600
	Medicine		intubations
Richmond, S. and J.	Resuscitation	2010	European Resuscitation Council Guidelines for Resuscitation 2010 Section 7. Resuscita-	150	11.5	0.569
Wyllie.			tion of babies at birth
Hawkes, C., et al.	Resuscitation	2017	Epidemiology and outcomes from out-of-hospital cardiac arrests in England	149	24.8	1.000
Arlt, M., et al.	Resuscitation	2010	Extracorporeal membrane oxygenation in Severe trauma patients with bleeding shock	149	11.5	0.565
Speroni, K.G., et al.	Journal of Emergency	2014	Incidence and cost of nurse workplace violence perpetrated by hospital patients or	148	16.4	0.758
	Nursing		patient visitors

reported that heavy workload, funding, and lack of interest in academic career might be the underlying factors [9,10]. With this regard, Turkey might be considered another example of considerable support for re- search in the scientific environment, which makes it the second most productive country, also related to physicians having a keen interest in academic careers [11]. This was also reported in a recent study by

Smith et al., which evaluated the EM research in the last two decades and stated that EM is relatively a new field in countries with an increas- ing publication trend, indicating an emerging research infrastructure [12]. Another study by Kokulu et al. that also evaluated the contribution of EM physicians to the literature between 2008 and 2017 showed sim- ilar distribution pattern of most productive countries, and concluded

Image of Fig. 4

Fig. 4. Word cloud matrix for Keyword Plus, author keywords, article title in all, and top-cited 100 articles.

that there was an increasing trend in the annual number of publications in some countries like Turkey [13]. The main difference between this study and ours is that the authors limited their research to the articles published by EM physicians, while we limited our database to the entire EM field. Since we evaluated the evolution of the EM research, re- searchers from other disciplines reporting their studies in EM were also included in our study. This might be accounted for possible contam- ination of other science fields in this study, but we favored the entire EM

research coverage.Evaluating the most frequent topics is critical to infer the research trends in a particular discipline. For such evaluation, we an- alyzed the most frequent terms in keywords and titles that are assumed to reflect the general scopes of the knowledge presented in the articles. Moreover, the thematic assessments also showed remarkable trends in research fields as essential, emerging/declining, interconnected, or motor themes. Based on overall scopes and trends in EM research, we grouped these findings into clinical entities based on the authors’ expert

Image of Fig. 5

Fig. 5. Thematic map of author keywords in articles.

opinions. Accordingly, our data found that cardiovascular emergencies, resuscitation, mortality, patient outcomes, emergency imaging, triage, education, and management were the most prominent research head- ings in the last decade. As an overall interpretation, these topics are in- evitably among the core dynamics of the EM field, and every EM specialist has to have in-depth knowledge of these. Thus, it is not unex- pected that these are the most frequent research areas in the EM litera- ture. A recent study that evaluated the 30-year thematic development in EM reported that the most frequent research topics were emergency medical services, management, satisfaction, and diabetic ketoacidosis based on the most frequent keywords used [14]. This study covered a larger timespan than ours and timed two decades back as a start point. This broad coverage provides a more comprehensive assessment, which shows that emergency management, medical services, or patient outcomes that may also be implied as satisfaction were generally stable themes over decades, which are also among the primary research topics recently. Another study that evaluated the top-cited 100 articles in EM as of 2014 reported that the most common research topics were cardio- vascular medicine, emergency department administration, toxicology, pain medicine, pediatrics, traumatology, and resuscitation [15]. The re- sults of this study were from two different databases as Scopus Library and Google Scholar, while our results were based on the WOS database. Although these databases overlap considerably, there is an inevitable possibility of uncovered literature. The reasons to prefer WOS in this study were the substantial coverage of the literature, and maintaining citation consistency to avoid overlaps of different databases. Moreover, there is a specific bias towards WOS in Turkey due to the academic pro- motions prioritizing publications in WOS indexes, which we also con- sidered primary criteria to identify the database used in our analyses.

Although not many studies reported the most frequent research fields per se, there is a more patient-oriented approach in scientific re- search, which is also the case in clinical applications. Tailored or person- alized medicine became more popular in the last decade, and the focus on mortality and patient outcomes may reflect an increasED shift to patient-oriented Outcome research. Moreover, the most frequent re- search topics in this study may be more likely to be funded, which can increase the chances of successful research and the ability to publish. Additionally, funding may lead to more robust data that can support ad- ditional secondary analyses and dedicated statistical support.

There are several important limitations. First, this is a Bibliometric analysis of the whole literature in the EM field based on the article ti- tles/keywords and may not completely reflect the topics covered in EM field. Second, we only studied a 10-year span from 2010 to 2019. This was intentional to avoid the impact of COVID-19 on the literature and future work would be important to look at the impact of COVID- 19 on the EM literature. Third, we only used a single data source and it is possible that we may have missed publications which were not published in WOS. The focus on original research may not reflect the broader range of publications and may have missed some articles with original data which were misclassified (e.g., correspondence, letters to the editor). Fourth, the top-cited articles also include a number of guide- lines, which might bias the trends found in this study in EM research. Fi- nally, the decision to limit to the English language was needed for keyword analysis, but may have underrepresented the publication and citation metrics for some countries.

Conclusion

In summary, we found that there is an increasing trend in the num- ber of EM publications since 2010 which has stabilized over the final five years. Most publications were led by authors in the United States followed by Turkey, Canada, Australia, and China. The most frequent

topics were cardiovascular emergencies, resuscitation, mortality, pa- tient outcomes, emergency imaging, triage, education, and manage- ment. These findings may provide insights into the current trends and scientific agendas of the EM research.

Funding sources/disclosures

This research did not receive any specific grant from funding agen- cies in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

Murat Cetin: Writing - original draft, Validation, Project administra- tion, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Brit Long: Resources, Project administration, Meth- odology, Data curation. Michael Gottlieb: Writing - review & editing, Writing - original draft, Visualization, Validation, Supervision, Project administration, Formal analysis, Data curation.

Declaration of Competing Interest

Authors declare no conflict of interest

Acknowledgments

None.

Appendix A. Supplementary data

Supplementary data to this article can be found online at https://doi. org/10.1016/j.ajem.2022.06.016.

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AJEM

A 10-year bibliometric analysis of publications in emergency medicine

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