Waqas Shuaib

The top 100 cited articles published in emergency medicine journals

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 administration, 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 < .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.

Ventriculoperitoneal Shunt Malfunction: Cumulative Effect of Cost, Radiation, and Turnaround Time on the Patient and the Health Care System

OBJECTIVE The purpose of this study was to reiterate the predominance of CT in evaluating ventriculoperitoneal shunt malfunction in terms of cost-effectiveness, reduction of radiation exposure, and turnaround time as the measurement parameters. MATERIALS AND METHODS This retrospective study included patients 18 years and older with a history of ventriculoperitoneal shunt insertion who presented to the emergency department with symptoms of shunt malfunction and underwent shunt series radiography and head CT within 12 hours. Shunt revision occurring contemporaneously with imaging was defined as revision within 48 hours of the original imaging report. The effective radiation dose was calculated by multiplying dose-length product from the scanner with the standard conversion coefficient k (k = 0.0021 mSv/mGy × cm). The turnaround time for patients who underwent both head CT and shunt series radiography was calculated from time of the first study to the time of completion of the last study. RESULTS There were 16 shunt revisions in 239 patients. The sensitivity of CT was 87.5%; specificity, 91.4%; positive predictive value, 42.4%; and negative predictive value, 99%. The sensitivity of shunt series radiography was 18.7%; specificity, 90.9%; positive predictive value, 13%; and negative predictive value, 93.9%. There were 223 observations of CT radiation dose per patient (mean, 1.87 ± 0.45). There also were 223 observations of shunt radiography radiation dose per patient (mean, 1.57 ± 0.60). The median turnaround time among patients undergoing CT and shunt radiography was 109 ± 84 minutes. CONCLUSION Shunt series radiography is a low-yield diagnostic imaging modality for identifying shunt malfunction and prolongs turnaround time, increases medical cost, and exposes patients to unnecessary radiation.

Nontraumatic acute aortic emergencies: Part 1, Acute aortic syndrome.

OBJECTIVE The aim of this article is to illustrate the imaging findings and analyze the spectrum of findings seen in patients with acute aortic syndrome. We also will discuss the overlaps in pathophysiologic and imaging findings among aortic syndromes. CONCLUSION Acute aortic syndrome includes acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. The most common clinical presentation is severely painful and potentially life-threatening abnormalities of the aorta. Differentiating among these aortic diseases is impossible by symptoms or physical evaluation. Therefore, any clinical suspicion should prompt immediate action including confirmatory noninvasive imaging. Prognosis of acute aortic syndromes is clearly related to prompt diagnosis and appropriate management. Accurate imaging interpretation can modify the natural history of acute aortic syndrome and improve prognosis.

Bibliometric analysis of the top 50 cited respiratory articles

Background: Citation classics have been published in almost all medical fields. The main objective of this study was to provide the readers with a complete updated guide using two different citation tracking sources in assessing respiratory literature published in respiratory specific or general medical journals. Methods: Scopus Library database (www.scopus.com) was used to determine the 50 most cited articles regarding respiratory medicine using the subject category “respiratory system.” The results from the database were sorted using the option “Times cited.” Results: The top 50 articles were published during the time period 1987–2008, with most articles (n = 22) published from 1996 to 2000.The topic that had the highest number of articles (n = 15) was chronic obstructive pulmonary disorders (COPD) followed by asthma (n = 10). Conclusion: A periodic evaluation of the top cited articles can help researchers identify the quality of work in respiratory system and pinpoint subtopics which have not been given due consideration.

Anatomy of success: 100 most cited articles in diabetes research.

Introduction: The number of citations an article receives is an important indication of its impact and its contribution to academia. There is a paucity of literature concerning top article citations in diabetes. The main objective of this investigation was to bridge this gap and to provide readers with a practical guide in evaluating diabetes literature. Methods: Scopus Library was searched to determine the citations of all published diabetes articles. A total of 100 articles were included in our investigation under the subject category ‘Diabetes, diabetes mellitus, and diabetics’. Two databases were used to extract citations. We did not apply any time restriction in our search. The top 100 cited articles were selected and analyzed by two independent investigators. We extracted immediacy index from ResearchGate. Results: The journal with the highest number of top 100 cited articles was The New England Journal of Medicine with 23, followed by 22 in Diabetes Care. The top article on the list received 17,779 citations. A statistically significant association was found between the journal impact factor and the number of top 100 cited articles (p < 0.005). The United States had the highest number of articles (59). Contrary to bibliometric analyses published in other medical fields, the largest subset of the diabetes articles (n = 54) were published in the 10-year period between 2000 and 2009. Conclusion: Our analysis provides an insight on the citation frequency of top cited articles published in diabetes to help recognize the quality of the works, discoveries and the trends steering the study of diabetes.

Imaging Foreign Bodies: Ingested, Aspirated, and Inserted.

Foreign bodies can gain entrance to the body through several mechanisms, ie, ingestion, aspiration, and purposeful insertion. For each of these common entry mechanisms, this article examines the epidemiology, clinical presentation, anatomic considerations, and key imaging characteristics associated with clinically relevant foreign bodies seen in the emergency department (ED) setting. We detail optimal use of multiple imaging techniques, including radiography, ultrasonography, fluoroscopy, and computed tomography to evaluate foreign bodies and their associated complications. Important imaging and clinical features of foreign bodies that can alter clinical management or may necessitate emergency intervention are discussed.

Firearms, bullets, and wound ballistics: An imaging primer

Based on its intrinsic mass and velocity, a bullet has an upper limit of wounding potential. Actual wound severity is a function of the bullet construction and trajectory, as well as the properties of the tissues traversed. Interpreting physicians must evaluate the bullet trajectory and describe patterns of injury resulting from the effect of energy transfer from the projectile into living tissue. A basic understanding of firearms, projectiles, and wound ballistics can help the interpreting physicians in conceptualizing these injuries and interpreting these cases.

Intra-abdominal solid organ injuries: an enhanced management algorithm.

The organ injury scale grading system proposed by the American Association for the Surgery of Trauma provides guidelines for operative versus nonoperative management in solid organ injuries; however, major shortcomings of the American Association for the Surgery of Trauma injury scale may become apparent with low-grade injuries, in which conservative management may fail. Nonoperative management of common intra-abdominal solid organ injuries relies increasingly on computed tomographic findings and other clinical factors, including patient age, presence of concurrent injuries, and serial clinical assessments. Familiarity with characteristic imaging features is essential for the prompt diagnosis and appropriate treatment of blunt abdominal trauma. In this pictorial essay, the spectrum of the American Association for the Surgery of Trauma organ injury scale grading system is illustrated, and a multidisciplinary management algorithm for common intra-abdominal solid organ injuries is proposed.

Colorectal Emergencies and Related Complications: A Comprehensive Imaging Review—Imaging of Colitis and Complications

OBJECTIVE Colorectal emergencies are a common presentation in the emergency medicine setting and their timely diagnosis plays a crucial role in avoiding dreaded complications. The quintessential role of a radiologist lies in identifying the cause, narrowing the differential diagnosis according to imaging features, and, most importantly, identifying the associated complications. CONCLUSION This review focuses on imaging features of the spectrum of colitides and the complications related to colitides.

Effect of Tube Voltage (100 vs. 120 kVp) on Radiation Dose and Image Quality using Prospective Gating 320 Row Multi-detector Computed Tomography Angiography.

Objectives: The objective of the following study is to evaluate the effect of reducing tube voltage from 120 to 100 kVp using prospective gating 320 row multi-detector computed tomography angiography on image quality and reduction in radiation dose. Materials and Methods: A total of 78 sequential patients were scanned with prospective electrocardiogram gating. A total of 45 patients (Group 1) with mean body mass index (BMI) 29 ± 2 and heart rate (HR) 57 ± 7 beats per minute (BPM) were scanned at 120 kVp. 33 patients (Group 2) with mean BMI 23 ± 3 and HR 58 ± 6 bpm were scanned at 100 kVp. Effective dose was calculated using dose length product and factor (k = 0.014). Quantitative assessment of image quality was calculated by measuring signal to noise ratio (SNR) and contrast to noise ratio (CNR) in the left ventricle and left main coronary artery. Two experienced cardiac radiologists using a three-point ordinal scale assessed subjectively image quality. Results: In Group 1, the median radiation dose was 5.31 mSv (95% confidence interval [CI]: 4.86-6.09) and for Group 2 (P = 0.009) the mean radiation dose was 3.71 mSv (95% CI: 2.76-4.87), representing 30% decrease in radiation dose. In multivariate analyses, adjusting for age, gender, HR, BMI, tube current and scan length, an absolute median reduction of 2.21 mSv (1.13-3.29 mSv) was noted in patients scanned with 100 kVp (P < 0.0001). The quantitative image quality (SNR and CNR) was not statistically significant between the groups. Subjective image quality was rated as good or excellent in 99% of coronary segments for both groups (P value was considered as non-significant). Conclusion: Our study suggests that radiation dose may be lowered from 120 to 100 kVp with preservation of image quality in patients whose BMI is ≤27.