Bibliometric Analysis of 25 Years of Emergency Medicine Research in Latin America.

Research Pioneers in Emergency Medicine—Reflections on Their Paths to Success and Advice to Aspiring Researchers: A Qualitative Study

The COVID-19 pandemic, caused by SARS-CoV-2, has significantly impacted global healthcare systems, leading to substantial adaptations and challenges. Emergency medicine physicians have been at the forefront of managing this crisis, necessitating a surge in related research efforts. This study aims to conduct a comprehensive bibliometric analysis of emergency medicine research related to COVID-19 to understand the evolving landscape and emerging trends. Systematic searches were conducted within the Web of Science Core Collection and PubMed databases using the query: ((“emergency medicine”) AND (“covid 19” OR “covid-19” OR “corona virus” OR “coronavirus” OR “SARS-CoV” OR “MERS-CoV” OR “COVID19”)) in the All Fields category. This search yielded 3,551 relevant results. Supplementary searches were performed using Carrot². The data were analyzed to identify publication counts, contributing authors, countries, journals, and key research themes. Additionally, Biblioshiny was used for the visual representation of the main themes and emerging trends, as well as for generating the word cloud. The analysis revealed a significant increase in emergency medicine research related to COVID-19 since 2020, with peaks in 2020 and 2021. Given the central role of emergency medicine in the pandemic response, it is expected that a significant proportion (68.1%) of publications originated from this field. However, beyond this expected distribution, this bibliometric analysis provides meaningful insights by highlighting key thematic trends within emergency medicine research, such as “emergency medicine” and “COVID-19”. These findings help in understanding the research focus, gaps, and evolving priorities in emergency medicine during the COVID-19 pandemic. This bibliometric analysis highlights the critical role of emergency medicine research in addressing the COVID-19 pandemic. The findings emphasize the importance of continued interdisciplinary collaboration and the integration of emerging technologies to enhance emergency care. Sustained investment in global health initiatives and research funding is crucial for preparing for future public health challenges.

NIH Launches Emergency Care Research Office: Coordinating Center Lauded but Challenges Noted

Our study objective was to describe the Canadian emergency medicine (EM) research community landscape prior to the initiation of a nationwide network. A two-phase electronic survey was sent to 17 Canadian medical schools. The Phase 1 Environmental Scan was administered to department chairs/hospital EM chiefs, to identify EM physicians conducting clinical or educational research. The Phase 2 Survey was sent to the identified EM researchers to assess four themes: 1) geographic distribution, 2) training/career satisfaction, 3) time/financial compensation, and 4) research facilitators/barriers. Descriptive analyses were conducted, and results were stratified by Canadian regions. A total of 92 EM researchers were identified in Phase 1; 67 (73%) responded to the Phase 2 Survey. Of those, 42 (63%) reported being clinical researchers, and 19 (45%) had a graduate degree. Three provinces encompassed most of the researchers (n = 35). Of the respondents, 61% had a research degree, 66% felt adequately trained for their research career, 73% had financial support, 83% had access to office spaces, 52% had no mentor during their first years of their career, 69% felt satisfied with their research career, and 82% suggested that they will still be conducting research in 5 years. EM researchers reported being adequately trained, even though only a little over half had a graduate degree. Only two-thirds had financial support, and mentorship was lacking in one-third of the participants. Not all respondents had a form of infrastructure, but most felt optimistic about their careers. The Canadian EM research environment could be improved to ensure better research capacity.

Injury care is a core part of daily emergency medicine (EM) clinical practice, accounting for over one-third of emergency department (ED) visits every year.1 It also remains a formidable burden to the public’s health in the United States. The Centers for Disease Control and Prevention (CDC) reports that in 2006, 179,065 Americans died as a result of injury,2 and in 2007, 29,756,586 suffered nonfatal injuries.3 Historically, the development of the science of injury prevention and control has paralleled the evolution of the specialty of EM. This was initially nested within the context of emergency medical services (EMS) and trauma systems development. In the 1966 landmark publication, Accidental Death and Disability: The Neglected Disease of Modern Society, the National Academy of Sciences and the National Research Council detailed the first examination of the country’s burden of injury morbidity and mortality. The report outlined specific recommendations calling for EMS development and meaningful federal agency guidance and oversight.4 Along with the first federal funding to establish EMS in the late 1960s and early 1970s came the establishment of the National Highway Safety Bureau (later known as the National Highway Traffic Safety Administration [NHTSA]). This emphasis on EMS contributed to the development and organization of EDs and specialty training of emergency physicians (EPs). As the specialty of EM began to grow in the 1970s, the public’s awareness of the continued high injury-related morbidity and mortality statistics raised the urgency for policy-makers to address the nation’s injury burden. As a result, state and federal health officials and researchers began to focus their efforts on population health to accurately describe and formulate plans to address the injury burden and its impact on U.S. communities. In 1985, the first of the landmark “red books,”Injury in America: A Continuing Public Health Problem, was published.5 This report outlined the magnitude of the national injury burden, and the gaps in addressing this burden comprehensively, and provided descriptions of opportunities for medical specialties to participate in reducing this burden. Subsequent national reports6 continued to reveal the cost of injury and the challenges in addressing this public health burden. Simultaneously, EM as a specialty began to build its intentional and positive influence in the future development of injury prevention and control activities and science. Over the past two and a half decades, EM’s efforts to address injury as a public health burden have led many EPs to engage in injury prevention and control activities through participation and leadership in surveillance and research, education, and advocacy. These collective efforts have fostered growth in the body of knowledge of injury science and have helped to lessen the burden on society. As the clinical specialty treating the entire spectrum of injury occurring in children and adults, EM is uniquely positioned to contribute to the science of injury prevention and control. At a population level, EM is able to provide understanding of types of injury patterns occurring, the risk factors for their occurrence, and the outcome of the injury. In creating epidemiologic profiles of injury patterns, interventions at both the individual and the population level can be developed and examined. Within states, EM contributes to injury surveillance with external cause coding (E-codes) in the hospital ED data system. Although these data are used primarily for administrative and billing purposes, they provide important state-level external cause of injury data for measuring the impact of nonfatal injury in that state, allowing policy-makers to make data-driven decisions regarding injury prevention.7 Several large national databases that utilize ED data on injured patients are frequently accessed and used by researchers both within and outside of EM to describe a specific injury problem and discuss mechanisms for prevention and control. One database that relies solely on ED data is the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP), which is a collaborative effort between the US Consumer Product Safety Commission and the CDC’s National Center for Injury Prevention and Control.8 Data on injury-related visits are obtained by NEISS-AIP from a national stratified probability sample of hospitals in the United States and its territories with a minimum of six beds and a 24-hour ED. NEISS-AIP collects data on initial visits for all categories of injuries treated in U.S. EDs and provides data on nearly 500,000 injury-related ED visits annually. Not only does EM contribute to the database through its clinical work, but researchers within the specialty have been consumers of the data and utilize it to further describe injury patterns.9–11 Another injury surveillance database that EM contributes to is the Crash Outcome Data Evaluation System (CODES) database that is maintained by NHTSA.12 It is a statewide population-based probabilistic linkage of police reports on motor vehicle crash (MVC), EMS, and hospital/ED data. EM researchers have used this database in describing transportation injury problems.13,14 Emergency physicians now lead many regional poison control centers. These centers provide important toxicologic expertise for patient care, as well as a large amount of data on the occurrence and outcomes of poisonings that is utilized by EM and non-EM researchers.15,16 The Drug Abuse Warning Network (DAWN)17 is a public health surveillance system that monitors drug-related visits to EDs and helps communities identify emerging problems that are risk factors for intentional and unintentional injuries. EM-based injury prevention research has also had a substantive role with both interventional and translational research at the patient care level and advancing clinical preventive services. One example is EM-based randomized clinical trials in the area of screening, brief intervention, and referral to treatment (SBIRT) for alcohol use disorders that have demonstrated decreased alcohol use,18 injury,19 or risky behaviors for injury occurrence.20 This has led to type II translational research21 (bedside to community) on how to best integrate SBIRT into routine EM care.22 The ED is frequently a treatment site for victims of interpersonal violence. This has allowed EM-based researchers to contribute to the knowledge development of this problem, as well as expand research to better screen for and intervene with victims.23–25 Motor vehicle crashes are the leading cause of injury death in the first three decades of life. Caring for the entire spectrum of MVC trauma victims allows EM to develop research foci in this area of testing and interventions to decrease future injury risk26 and contributing to the clinical research of care of the injured trauma patient to prevent secondary injury. It has also allowed EM to contribute to the science involving the biomechanics of crash injury27,28 and an appropriate EMS response to reduce the occurrence of secondary injury.29,30 As a result of growing interest and leadership in injury prevention and control, several departments of EM began to organize their efforts and form injury prevention centers. These centers have had a research focus, but also have efforts directed at injury prevention education and community programs. The growing number of EM-led centers reflects the increased leadership that the specialty brings to the field of injury prevention and control. These centers31–35 have a track record of state and federal research funding for injury prevention and control research, as well as incorporating missions for education and community outreach. Several offer fellowship training in injury prevention and control for EM trainees. Instruction to EM residents on injury prevention was first addressed in 1990,36 with a short course with the goal to “provide information on motor vehicle crashes in a public health framework.” As others in EM began to publish and lecture on this topic, efforts to increase health care professional training in injury prevention increased.37 The Institute of Medicine (IOM) report “Who Will Keep the Public Healthy” noted the importance of injury prevention and control education for the well-being of the population and called for health care professional training programs to make injury prevention training a higher priority.38 EPs in training shared the same belief as the IOM and wanted more injury prevention and control education in their training. In one study, 97% of EM residents in California surveyed between 1992 and 1993 felt that injury prevention was a critical aspect of their work, and 70% felt that it was a necessary focus in their training.39 Many articles and efforts from national organizations, such as the Association of American Medical Colleges, have called for an incorporation of injury prevention and control into medical school curricula40,41 and further advancement into medical training programs, including EM. The integration of injury prevention and control and EM practice and training has continued to grow. Injury prevention and control is now recognized as integral to EM residency training, although it still needs more emphasis in the core curriculum. Medical schools are increasingly recognizing the opportunity injury has in integrating basic science, clinical care, and population health sciences for their students. There are EM-based injury control and prevention fellowships, complementing the traditional trauma surgery fellowships that exist at many academic health centers in the United States. It is important to emphasize the opportunity that EM has to advance the science of injury prevention and control and bring the various injury control stakeholders together. A good example of this can be found in the context of toxicology and poisonings. Acute injury from chemical agents continues to be a growing and significant cause of mortality and morbidity. It is now the leading cause of injury death in Americans age 35–44 years.2 EM already plays a significant national leadership role in toxicology and poison center activities. According to the American College of Emergency Physicians, there are currently more than 20 fellowships in EM toxicology. Emergency medicine leaders in disaster preparedness and response from all physical agents including chemical are also in a strong position to reduce fragmented responses and further improve our overall disaster preparedness by unifying response principles and integrating the science of injury prevention and control. The acute care research agenda of the CDC’s National Center for Injury Prevention and Control calls for case studies that further inform our abilities to address mass casualties from physical agents.42 Among the central goals of training future EM leaders, and in unison with Accreditation Council for Graduate Medical Education (ACGME) principles that guide our resident training43 is the development of professionalism and duty to society in EM trainees.44 Consistent with this, EPs have moved to purposely teach and lead by example as advocates for primary injury prevention and control programs and policies. EM leaders have also organized to educate the community and conduct important policy-relevant injury research expertise. Today, state and federal government agencies continue to seek support from EPs to provide important insights and expertise into injury-related issues that are affecting the nation. EM leaders have made and continue to make substantial contributions within these federal agencies including the CDC, the NHTSA, the Department of Health and Human Services, and the Health Resources and Services Administration. While there has been significant growth in both injury prevention and control science and EM over the past several decades, the current challenges to EM outlined in recent IOM reports45–47 appear to be daunting and potential indicators of a downturn. However, some of these same challenges reveal tangible opportunities for continued parallel growth in injury prevention and control science and EM. One of the most notable areas where such opportunity exists is within the National Institutes of Health’s creation of the Clinical and Translational Science Awards (CTSA). Understanding that each CTSA will have to be understood in its respective institutional culture and context, opportunities for collaboration and EM investigator–initiated training and research in injury prevention and control should exist. Training EPs in translational sciences has the potential to significantly enhance the capacity for future EM researcher and specialty success while advancing the science of injury prevention and control. The development and growth of injury prevention and control science and EM as a medical specialty have had paralleled success. The spectrum of leadership of EPs in injury prevention began at the bedside with the desire of EPs to deliver the very best care to injured patients. Many EPs and departments have gone beyond the doors of the ED and have been instrumental in influencing important systems of surveillance, clinical care, and health policy so that primary and secondary prevention efforts are effectively developed and implemented. Still other EPs have gone further to champion injury prevention and control in a variety of prominent leadership positions at state and federal levels. Injury research centers, with primary and collaborative EM leadership, continue to flourish nationally, with EPs partnering with colleagues in surgery, pediatrics, psychiatry, epidemiology, and other disciplines on injury research, advocacy, and policy. The future of EM leadership and growth in injury prevention and control science remains promising, with opportunities for the development and execution of robust research that will influence the public’s health in meaningful and measurable ways.

We sought to 1) identify best practices for training and mentoring clinician researchers, 2) characterize facilitators and barriers for Canadian emergency medicine researchers, and 3) develop pragmatic recommendations to improve and standardize emergency medicine postgraduate research training programs to build research capacity. We performed a systematic review of MEDLINE and Embase using search terms relevant to emergency medicine research fellowship/graduate training. We conducted an email survey of all Canadian emergency physician researchers. The Society for Academic Emergency Medicine (SAEM) research fellowship program was analysed, and other similar international programs were sought. An expert panel reviewed these data and presented recommendations at the Canadian Association of Emergency Physicians (CAEP) 2014 Academic Symposium. We refined our recommendations based on feedback received. Of 1,246 potentially relevant citations, we included 10 articles. We identified five key themes: 1) creating training opportunities; 2) ensuring adequate protected time; 3) salary support; 4) infrastructure; and 5) mentorship. Our survey achieved a 72% (67/93) response rate. From these responses, 42 (63%) consider themselves clinical researchers (i.e., spend a significant proportion of their career conducting research). The single largest constraint to conducting research was funding. Factors felt to be positive contributors to a clinical research career included salary support, research training (including an advanced graduate degree), mentorship, and infrastructure. The SAEM research fellowship was the only emergency medicine research fellowship program identified. This 2-year program requires approval of both the teaching centre and each applying fellow. This program requires training in 15 core competencies, manuscript preparation, and submission of a large grant to a national peer-review funding organization. We recommend that the CAEP Academic Section create a process to endorse research fellowship/graduate training programs. These programs should include two phases: Phase I: Research fellowship/graduate training would include an advanced research university degree and 15 core learning areas. Phase II: research consolidation involves a further 1-3 years with an emphasis on mentorship and scholarship production. It is anticipated that clinician scientists completing Phase I and Phase II training at a CAEP Academic Section-endorsed site(s) will be independent researchers with a higher likelihood of securing external peer-reviewed funding and be able to have a meaningful external impact in emergency medicine research.

The 2012 Academic Emergency Medicine consensus conference on education research in emergency medicine (EM) addressed various issues, including that of ethics in medical education research for EM. Education research in EM is essential to patient care and safety, and with recent advances in simulation and the advent of the Milestones project, it will become even more vital. Education research in EM is guided by the same principles that guide the ethical conduct of all human subjects' research: respect for persons, beneficence, and justice. Regulatory provisions and widely accepted ethical standards provide a framework for research in EM education; however, special considerations exist for education research. To ensure patient and trainee safety and to maintain the integrity of new knowledge, ethical considerations should remain at the forefront of EM education research. For EM education researchers, recognition of the vulnerability of residents, medical students, and others as research subjects is paramount. This article fills an important gap by outlining the principles guiding education research in EM, exploring the ethical challenges and approaches to education research, and offering a framework and future directions for the ethical conduct of education research in EM.

To identify and characterize emergency medicine (EM) researchers who, since 1990, have served on a steering committee (SC) or as overall principal investigator (PI) of an industry-sponsored, multicenter clinical trial involving a pharmaceutical or device. North American EM research directors (RDs) and other prominent EM investigators (for those hospitals without a RD) were identified from eight sources, including the Society for Academic Emergency Medicine RD Interest Group and the Multicenter Airway Research Collaboration (MARC) database. The identified investigators were sent a screening survey requesting information regarding industry-sponsored clinical research at their site. The individual EM investigators identified by this screening survey were then interviewed by telephone (validation survey) to further explore their leadership experience in industry-sponsored clinical trials. Of 153 identified RDs and prominent EM researchers, 138 responded to the screening survey (90% response rate). Eighty-five EM investigators reportedly had served on a SC or as overall PI for an industry-sponsored clinical trial. Of these 85 North American EM investigators, 77 were available for a structured telephone interview (91% response rate). Although 41 (53%) of the investigators confirmed their leadership role, 36 (47%) had not served in either role. Among the 41 confirmed investigators, 19 (25%) had served as a SC member, 10 (13%) had served as overall PI, and 12 (16%) had experience in both roles. Individual responses provided suggestions for pursuing such leadership positions. These data suggest the opportunity to expand EM leadership in industry-sponsored clinical trials and demonstrate the need for validation of reports obtained by a departmental research contact. The suggestions from EM researchers who have attained these leadership roles may provide strategies for investigators interested in pursuing these positions.

Objective: To identify and characterize emergency medicine (EM) researchers who, since 1990, have served on a steering committee (SC) or as overall principal investigator (PI) of an industry‐sponsored, multicenter clinical trial involving a pharmaceutical or device. Methods: North American EM research directors (RDs) and other prominent EM investigators (for those hospitals without a RD) were identified from eight sources, including the Society for Academic Emergency Medicine RD Interest Group and the Multicenter Airway Research Collaboration (MARC) database. The identified investigators were sent a screening survey requesting information regarding industry‐sponsored clinical research at their site. The individual EM investigators identified by this screening survey were then interviewed by telephone (validation survey) to further explore their leadership experience in industry‐sponsored clinical trials. Results: Of 153 identified RDs and prominent EM researchers, 138 responded to the screening survey (90% response rate). Eighty‐five EM investigators reportedly had served on a SC or as overall PI for an industry‐sponsored clinical trial. Of these 85 North American EM investigators, 77 were available for a structured telephone interview (91% response rate). Although 41 (53%) of the investigators confirmed their leadership role, 36 (47%) had not served in either role. Among the 41 confirmed investigators, 19 (25%) had served as a SC member, 10 (13%) had served as overall PI, and 12 (16%) had experience in both roles. Individual responses provided suggestions for pursuing such leadership positions. Conclusions: These data suggest the opportunity to expand EM leadership in industry‐sponsored clinical trials and demonstrate the need for validation of reports obtained by a departmental research contact. The suggestions from EM researchers who have attained these leadership roles may provide strategies for investigators interested in pursuing these positions.

IntroductionThe application of structural competency and structural vulnerability to emergency medicine (EM) research has not been previously described despite EM researchers routinely engaging structurally vulnerable populations. The purpose of this study was to conduct a scoping review and consensus-building process to develop a structurally competent research approach and operational framework relevant to EM research.MethodsWe conducted a scoping review focused on structural competency and structural vulnerability. Results of the review informed the development of a structural competency research framework that was presented throughout a multi-step consensus process culminating in the 2021 Society for Academic Emergency Medicine Consensus Conference. Feedback to the framework was incorporated throughout the conference.ResultsThe scoping review produced 291 articles with 123 articles relevant to EM research. All 123 articles underwent full-text review and data extraction following a standardized data extraction form. Most of the articles acknowledged or described structures that lead to inequities with a variety of methodological approaches used to operationalize structural competency and/or structural vulnerability. The framework developed aligned with components of the research process, drawing upon methodologies from studies included in the scoping review.ConclusionThe framework developed provides a starting point for EM researchers seeking to understand, acknowledge, and incorporate structural competency into EM research. By incorporating components of the framework, researchers may enhance their ability to address social, historical, political, and economic forces that lead to health inequities, reframing drivers of inequities away from individual factors and focusing on structural factors.

Emergency medicine: past, present, and future challenges

The objectives were to 1) evaluate the inclusion of sex and gender in publications by emergency medicine (EM) researchers following the 2014 federal mandate and an Academic Emergency Medicine consensus conference on sex- and gender-based research and 2) assess trends compared with 2011 status report that showed 29% studies used sex and gender in the study design and 2% reported it as a primary outcome. Using MEDLINE, the term "emergency" was used to identify all English-language studies of adult humans published between 2014 and 2017 as EM affiliated (i.e., the first, second, or last author belonged to an EM section, division, center, or institution functioning as emergency department). Four trained abstractors reviewed the data using a standardized data abstraction form. The search revealed 6,442 articles using the selected "emergency" terms, and 2,628 original studies coded as EM-affiliated publications were reviewed, 2,340 met inclusion criteria, and 2,336 were analyzed. This compared to 750 articles reviewed in 2011 using similar search strategy. The adjusted inter-rater reliability for data abstraction was 97% (95% confidence interval [CI]=95.4%-98.6%]. The leading study areas contributing the most articles were cardiovascular (17.5%), administration/crowding (15.8%), infectious diseases (9.2%), trauma/injury (9.2%), emergency medical services (6.1%), and pulmonary (6.1%). Eighty-six percent (n=1,921) reported the sex/gender composition of the sample and 0.4% (n=8) reported transgender identity. Thirty-four percent used sex/gender in the study design, with 27% (n=609) reporting it as a control variable, 24% (n=543) as an independent variable, and 2% using sex/gender as primary outcome. Studies funded by federal sources were significantly more likely to include sex/gender in the study design than other sources of funding (odds ratio= 1.77; 95% CI= 1.4-2.2). Compared to 2011, we noted an increase in the number of EM scholarship and use of sex and gender in study design, yet the proportion evaluating it as a primary outcome remained unchanged.

All academic medical specialties have the obligation to continuously create new knowledge that will improve patient care and outcomes. Emergency medicine (EM) is no exception. Since its origins over 50years ago, EM has struggled to fulfill its research mission. EM ranks last among clinical specialties in the percentage of medical school faculty who are National Institutes of Health (NIH)-funded principal investigators (PIs; 1.7%) and the percentage of medical school departments with NIH-funded PIs (33%). Although there has been a steady increase in the number of NIH-funded projects and total NIH dollars, the slowing growth in the number of NIH-funded PIs and lack of growth in the number of EM departments with NIH-funded PIs is cause for concern. In response, the Association of Academic Chairs of Emergency Medicine (AACEM) Research Task Force proposes a set of 2030strategic goals for the EM research enterprise that are based on sustaining historic growth rates in NIH funding. These goals have been endorsed by the AACEM Executive Committee and the boards of Society for Academic Emergency Medicine (SAEM), American College of Emergency Physicians (ACEP), and American Academy of Emergency Medicine (AAEM). The 2030strategic goals include 200NIH-funded projects led by 150 EM PIs in at least 50 EM departments with over $100M in annual funding resulting in over 3% of EM faculty being NIH-funded PIs. Achieving these goals will require a targeted series of focused strategies to increase the number of EM faculty who are competitive for NIH funding. This requires a coordinated, intentional effort with investments at the national, departmental, and individual levels. These efforts are ideally led by medical school department chairs, who can create the culture and provide the resources needed to be successful. The specialty of EM has the obligation to improve the health of the public and to fulfill its research mission.

This paper attempts to provide a broader view into the ethical issues surrounding the field of emergency medicine (EM) research. It starts from defining bioethically relevant features of EM and presents this field in the context of different models of health care provider-patient relationship. The paper also provides a short overview of the "post-Nuremberg" evolution of the main international research ethics guidelines relevant to EM research which demonstrates a tendency of liberalization of research on incapable persons. This tendency culminates with the exceptions to informed consent for EM research which is supposed to be balanced by other research ethics principles, especially a careful rationing of risks and benefits. This finally brings us towards a critical analysis of the minimal risk standard which is one of the main fundamental safeguards in EM research.

Clarivate Analytics’ Web of Science Core Collection, a comprehensive database consisting of ten sub-datasets, is increasingly applied in academic research across over two hundred Web of Science categories. 271 English language SCIE and SSCI papers published in 2017–2018 from the category of Information Science and Library Science have mentioned “Web of Science” in the topic field. A manual check of the full texts of these papers reveals that 243 of them have used “Web of Science Core Collection” as the data source but over half of them haven’t specified the sub-datasets of Web of Science Core Collection used in the study. Since many institutions may only subscribe to a customized subset of the whole core collection, the non-transparency of the data source will hinder the reproducibility of some corresponding studies. This study suggests that researchers should specify the sub-datasets and corresponding coverage timespans when using Web of Science Core Collection as the data source.