General Surgery Journals Research Articles

Sex differences in altmetric attention scores and traditional impact metrics of top-cited general surgery literature: Cracks in the ceiling?

Sex disparities have previously been identified in surgical academia. This study examines sex differences in the top-cited contemporary general surgery articles and compares Altimetric Attention Score (AAS) and other impact metrics between male and female corresponding authors (CAs). We conducted a bibliometric analysis of the 100 most cited articles published between 2019 and 2021 in each of the top 10 general surgery journals based on the 2021 Journal Impact Factor. Impact metrics included AAS, citation count, and H-index of the CA. We used multivariable regression analyses to investigate whether the sex of the CA or first author (FA) was independently associated with AAS and citation count. Among 1000 articles, 23.1% had female CAs and 27.4% female FAs. Female CA articles had higher AAS (13.0 [2.0-63.0] vs. 8.0 [1.0-28.5]; p<0.001) and lower H-indices (24.0 [11.0-45.0] vs. 31.0 [17.0-50.0]; p=0.015). Although median citation count did not differ by CA sex, articles with Level 1 evidence and a female CA were cited more often (35.5 [24.0-85.0] vs. 25.0 [16.0 vs. 46.0]; p<0.05). In multivariable regression, female CA articles had higher AAS (OR: 1.002 [95% CI: 1.001-1.004]) and lower H-index (OR: 0.987 [95% CI: 0.977-0.997]). Despite having similar citation counts, articles authored by female CAs exhibit higher AAS scores compared to those authored by their male counterparts. While it is heartening that research authored by female surgeons achieves significant visibility, it remains to be understood how this translates into academic impact and scholarly recognition.

Accuracy of Conflicts in Interest in General Surgical Journals.

To evaluate the accuracy of self-reported conflicts of interest (COIs) for articles published in prominent minimally invasive and general surgical journals. Accurate reporting of industry relationships and COIs is crucial for unbiased assessment of a particular study. Despite the enactment of COI laws, such as the Physician Payments Sunshine Act in 2010, prior work suggests that 40-70% of self-reported COIs have discrepancies. We utilized three public databases -- Open Payments (USA), Disclosure UK, and Disclosure Australia -- to assess the accuracy of COI disclosures among authors of 918 published articles from these respective countries. Seven journals were utilized to review the COIs for authors of manuscripts published in 2022 - JAMA Surgery, Annals of Surgery, British Journal of Surgery (BJS), Journal of American College of Surgeons (JACS), Surgical Endoscopy, Obesity Surgery, and Surgery for Obesity and Related Diseases (SOARD). Among the analyzed 6206 authors, 5675 belonged to countries of interest: USA (4282), UK (718), and Australia (213). Of these, 774 authors (12.5%) self-reported a conflict of interest in their papers. Overall, only 4055 researchers (69.1%) reported COIs accurately. Authors from the US had the lowest accuracy of reporting COI at 69% as opposed to UK (93%) and Australia (96%). Inaccurate COI reporting was most common in corresponding/senior authors (39%) and least common amongst first authors (18%). Most payments in excess of $50,000 made to authors by an industry sponsor were not disclosed appropriately. Our study shows that inaccuracy of self-reported COIs in general surgery journals remains high at 31%. While our findings should encourage authors to overreport any possible COI, journals should consider verifying the authors' COI to facilitate more accurate reporting.

Journal Metrics of Orthopaedic Journals between 2016 and 2021: Trends and Comparisons with Other Specialties.

Bibliometric analysis plays a crucial role in elucidating publication trends and aids scholars in gauging the reach of prospective journals for their research dissemination. Concerns with impact factor (IF) have led us to examine the trends in IF, corrected IF (cIF), and Citescore in orthopaedic journals from 2016 to 2021 and compare them with internal medicine and general surgery journals. Journal IF and cIF were obtained from Journal Citation Reports and Citescore data from the Elsevier Scopus database for the years 2016 to 2021. Orthopaedic journals were categorized, and 10 medicine and surgery journals were selected for comparison. Mean values were analyzed to identify trends. The study included 52 orthopaedic journals, evenly split between the United States and the rest of the world, predominantly publishing in English. Mean IF in orthopaedic journals increased from 1.93 (2016) to 2.78 (2021), with similar rises in cIF and Citescore. These trends were consistent in specialty and general orthopaedic journals. No significant differences were found in mean IF between these categories. Medicine and surgery journals also experienced significant IF increases. Orthopaedic journals have experienced growing esteem and extent from 2016 to 2021. Specialty and general orthopaedic journals showed parallel growth. Researchers can utilize this analysis for informed publishing decisions, potentially expanding their readership.

The geographic diversity of authorship in leading general surgery journals; A study of 24,332 authors

BackgroundResearch guides evidence-based general surgery practice, advocacy, policy and resource allocation, but is seemingly lacking representation from those countries with greatest disease burden and mortality. Accordingly, we conducted a geographic study of publications in the most impactful general surgery journals worldwide. MethodsThe six general surgery journals with the highest 2020 impact factors were selected. Only journals specific to general surgery were included. For all original articles over the past five years, the affiliated country and city were extracted for the first, second and last author. Number of publications were adjusted per capita, and compared to Human Development Index (HDI) using logistic regression. Results8274 original articles were published in the top six ranked general surgery journals over 2016–2020, with 24,332 affiliated authors. Authors were most commonly associated with the US (27.88%), Japan (9.09%) and China (8.46%), or per capita, The Netherlands, Sweden and Singapore. There is a linear association between publishing in a top six journal and HDI of country of affiliation. Just four publications were from medium or low HDI countries over the period. ConclusionAuthorship in leading general surgery journals is predominantly from wealthy, Western countries. Authorship is associated with affiliation with a high HDI country, with few authors from medium or low HDI countries. There is a lack of representation in literature from Africa, Russia, and parts of Southeast Asia, and thus a lack of locally relevant evidence to guide surgical practice in these areas of high disease burden and low life expectancy.

Global hemodialysis vascular access care: Three decades of evolution.

The development of vascular access for hemodialysis has come a long way since 1943 when the first hemodialysis treatment was performed in humans by connecting an artery and vein using an external glass canula. Since then, vascular access care has evolved robustly through contributions from numerous countries and professional nephrology societies, worldwide. To understand the global distribution and contribution of different specialties to medical literature on dialysis vascular access care, we performed a literature search from 1991 to 2021 and identified 2768 articles from 74 countries. The majority of publications originated from the United States (41.5%), followed by China (5.1%) and the United Kingdom (4.6%). Our search results comprise of observational studies (43%), case reports/series (27%), review articles (16.5%) and clinical trials (12%). A large proportion of articles were published in Nephrology journals (49%), followed by General Medicine (14%), Surgery (10%), Vascular Medicine (8%), and Interventional Radiology journals (4%). With the introduction of interventional nephrology, nephrologists will be able to assume the majority of the responsibility for dialysis vascular access care and above all maintain a close interdisciplinary collaboration with other specialties to provide optimum patient care. In this review article, we discuss the history, evolving knowledge, challenges, educational opportunities, and future directions of dialysis vascular access care, worldwide.

Modern Impact of Surgery Journals: Associations Between Impact Factor, H5-Index, and Altmetric Score

IntroductionWhile impact factor (IF) remains the “gold standard” metric for journal quality, newer metrics are gaining popularity. These include the H5-index and journal Altmetric Attention Score (AAS). We explored the relationship between the IF, H5-index, and AAS for core general surgery (GS) and subspecialty journals. MethodsFor all GS and subspecialty journals with a Clarivate IF, H5-index (January 1, 2017, to December 31, 2021) and journal AAS were obtained. Journal Twitter presence and activity was sourced from Twitter and the Twitter application programming interface. Spearman's correlations were assessed for numeric variables. ResultsA total of 105 journals were included, around half (49/105; 46.7%) of which were core GS journals. Median IF was 2.48 and median H5-index 19. Journal IF demonstrated a strong correlation with H5-index overall (r = 0.81), though this ranged from r = 0.95 (P < 0.01) for vascular surgery to r = 0.77 (P < 0.01) for plastic surgery journals. AAS was moderately correlated with the IF and H5-index (r = 0.59 and 0.62, respectively; both P < 0.01). R2 values ranging indicated that 66% of the variation in the H5-index and 35% of the variation in AAS was explained by the IF. Just over half the journals had a Twitter account (54/105; 51.4%). Journals with a Twitter account also had a significantly higher IF, H5-index, and AAS than those without a Twitter account (all P < 0.01). AAS was moderately correlated with Twitter activity (r = 0.59) and Twitter followers (r = 0.69). ConclusionsAcross GS and subspecialty journals, journal IF correlates strongly with the H5-index and moderately with AAS. However, only 35% of variation in AAS and 66% of variation in the H5-index is explained by the IF, indicating that these metrics measure unique aspects of journal quality. The future growth of surgical journals should be geared towards improving across multiple metrics, including both the conventional and the contemporary, while leveraging social media to improve readership and eventual academic impact.

Gender representation in the authorship of general surgery journals

Gender representation in the authorship of general surgery journals

The Use of Facial Recognition Software and Published Manuscripts to Examine Trends in Surgical Editorial Board Diversity

IntroductionRecent social justice movements have highlighted the need for improved diversity and inclusion. These movements have emphasized the need for inclusivity of all genders and races in all sectors including surgical editorial boards. There is currently not an established, standardized method to assess the gender, racial, and ethnic makeup of surgical editorial board rosters, yet artificial intelligence is a method that can be utilized to determine gender and race in an unbiased manner. The aim of the present study is to determine if recent social justice movements correlate with an increase in diversity-themed articles published and if there is an increase in the gender and racial makeup of surgical editorial boards determined by artificial intelligence software. MethodsImpact factor was used to assess and rank highly regarded general surgery journals. The website of each of these journals was examined for pledges of diversity in their mission statements and core beliefs of conduct. To determine the number of diversity-themed articles that were published during 2016 and 2021, each surgical journal was analyzed for diversity-themed articles using 10 specific keywords in PubMed. To determine the racial and gender makeup of editorial boards in 2016 and 2021, we obtained the current and the 2016 editorial board roster. Roster member images were collected from academic institutional websites. Betaface facial recognition software was used to assess the images. The software assigned the gender, race and ethnicity of the image supplied. Betaface results were analyzed using a Chi Square Test of Independence. ResultsWe analyzed 17 surgical journals. Only four of 17 journals were found to have diversity pledges on their website. For diversity themed publications, 1% of articles in 2016 and 2.7% in 2021 were published specifically about diversity. There was a significant increase in the amount of diversity articles/journal published per year in 2016 (6.59) compared to 2021 (25.94, P < 0.001). There was no correlation between impact factor and articles that publish diversity keywords. 1968 editorial board member images were analyzed using Betaface software to determine gender and race in both time periods. There was no significant increase in diversity of editorial board members regarding gender, race, and ethnicity temporally from 2016 to 2021. ConclusionsIn the present study, we found that although the number of diversity-themed articles has increased over the last 5 y, however the gender and racial makeup of surgical editorial boards has not changed. Further initiatives are needed to better track and diversify the gender and racial composition of surgical editorial boards.

The Quality of Otolaryngology- Head and Neck Surgery Literature over the Last Decade.

To describe the changes in the quality of the Otolaryngology-Head and Neck Surgery (OTOHNS) literature over the last decade, and compare it to other surgical-based fields. Based on impact factors, the top eight clinical U.S. OTOHNS journals were selected, and articles were analyzed from 2020 (Oto 2020) and compared to 2010 (Oto 2010). This was done similarly for Neurosurgery, Orthopedic, Ophthalmology, and General Surgery journals in 2020 (non-Oto). To limit bias and account for random variability, the first 10 research articles from each journal in each group were included. Data regarding the study type, level of evidence, use of confidence intervals, and funding source were collected. Based on an a priori power analysis, 160 articles were analyzed for Oto 2010 and Oto 2020. Compared to Oto 2020, Oto 2010 had more level 1 and 2 evidence (12 vs. 4; p=0.032) and less reporting of confidence intervals (10 vs. 32; p < 0.001). Comparing the top 160 articles from 2020 from Non-Oto and OTOHNS (Oto), Non-Oto had more level 1 and 2 evidence (19 vs. 6; p=0.0047), more randomized controlled trials (8 vs. 1; p=0.016), and less reporting of confidence intervals (42 vs. 58; p=0.009). High quality studies remain relatively scarce in the OTOHNS literature. Although reporting of confidence intervals has improved over the last decade, aggregate levels of evidence and extramurally funded studies lag behind other surgical-based fields. Better study design will provide stronger evidence basis, in hopes of improving clinical care. N/A Laryngoscope, 133:1853-1856, 2023.

Contemporary trends in the level of evidence in general thoracic surgery clinical research.

The large volume of scientific publications and the increasing emphasis on high-quality evidence for clinical decision-making present daily challenges to all clinicians, including thoracic surgeons. The objective of this study was to evaluate the contemporary trend in the level of evidence (LOE) for thoracic surgery clinical research. All clinical research articles published between January 2010 and December 2017 in 3 major general thoracic surgery journals were reviewed. Five authors independently reviewed the abstracts of each publication and assigned a LOE to each of them using the 2011 Oxford Centre for Evidence-Based Medicine classification scheme. Data extracted from eligible abstracts included study type, study size, country of primary author and type of study designs. Three auditing processes were conducted to establish working definitions and the process was validated with a research methodologist and 2 senior thoracic surgeons. Intra-class correlation coefficient was calculated to assess inter-rater agreement. Chi-square test and Spearman correlation analysis were then used to compare the LOE between journals and by year of publication. Of 2028 publications reviewed and scored, 29 (1.4%) were graded level I, 75 (3.7%) were graded level II, 471 (23.2%) were graded level III, 1420 (70.2%) were graded level IV and 33 (1.6%) were graded level V (lowest level). Most publications (94.9%) were of lower-level evidence (III-V). There was an overall increasing trend in the lower LOE (P < 0.001). Inter-rater reliability was substantial with 95.5% (95%, confidence interval: 0.95-0.96) level of agreement between reviewers. General thoracic surgery literature consists mostly of lower LOE studies. The number of lower levels of evidence is dominating the recent publications, potentially indicating a need to increase the commitment to produce and disseminate higher-level evidence in general thoracic surgery.

Systematic review reporting quality within dermatology: Bibliometric trends compared with general medicine and general surgery from 2008 to 2017

To the Editor: Despite the adaptation of high-evidence guidelines, eg, Preferred Reporting Items for Systematic Reviews and Meta-Analyses 1 Liberati A. Altman D.G. Tetzlaff J. et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009; 62: e1-e34https://doi.org/10.1371/journal.pmed.1000100 Crossref PubMed Scopus (8822) Google Scholar (PRISMA) for systematic reviews (SRs), low reporting quality persists in scientific publications, including in the field of dermatology. 2 Croitoru D.O. Huang Y. Kurdina A. Chan A.W. Drucker A.M. Quality of reporting in systematic reviews published in dermatology journals. Br J Dermatol. 2020; 182: 1469-1476https://doi.org/10.1111/bjd.18528 Crossref PubMed Scopus (10) Google Scholar , 3 Cook C. Checketts J.X. Atakpo P. Nelson N. Vassar M. How well are reporting guidelines and trial registration used by dermatology journals to limit bias? A meta-epidemiological study. Br J Dermatol. 2018; 178: 1433-1434https://doi.org/10.1111/bjd.16135 Crossref Scopus (3) Google Scholar , 4 Mimouni D. Pavlovsky L. Akerman L. David M. Mimouni F.B. Trends in dermatology publications over the past 15 years. Am J Clin Dermatol. 2010; 11: 55-58https://doi.org/10.2165/11530190-000000000-00000 Crossref Scopus (13) Google Scholar Poor reporting quality is an established issue; 93% of SRs in 5 high-impact dermatology journals missed ≥1 PRISMA checklist items. 2 Croitoru D.O. Huang Y. Kurdina A. Chan A.W. Drucker A.M. Quality of reporting in systematic reviews published in dermatology journals. Br J Dermatol. 2020; 182: 1469-1476https://doi.org/10.1111/bjd.18528 Crossref PubMed Scopus (10) Google Scholar ,5 Atakpo P. Vassar M. Publication bias in dermatology systematic reviews and meta-analyses. J Dermatol Sci. 2016; 82: 69-74https://doi.org/10.1016/j.jdermsci.2016.02.005 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar To gauge the percentage of methodologically rigorous SRs among those labeled as such, a subgroup analysis of 150 articles was conducted within a larger bibliometric analysis to compare the levels of evidence published in dermatology, general medicine, and general surgery journals.

Who is Committed to Education? An Analysis of Surgical Education Research Publications

Advances in surgical training have led to the recent emergence of surgical education research. While the importance of surgical education research is well recognized, not all surgical journals are publishing these works. The objective of this study was to analyze the volume and types of surgical education publications in general surgery and surgical subspecialty journals. A PubMed search string was developed to identify surgical education publications in general surgery (GS, n = 10) and surgical subspecialty (SS, n = 16) journals from 2015 to 2019. Publications were catalogued into 7 categories: curriculum and/or teaching, trainee assessment, program evaluation, wellness and/or burnout, resident research, case outcomes with resident involvement, and other. Journals were also categorized by impact factor into 3 groups. Statistical analysis was performed using linear regression and Wilcoxon rank-sum to analyze differences in education publication number and percent between GS and SS journals, as well as between different impact factor groups. The median proportion of surgical education publications was 1.2% (IQR 0.3-2.8%) of total publications for journals queried. The highest proportion of surgical education publications by a journal was 13.9%. All other journals had median ≤ 5.5%. GS journals had a significantly higher median percent of surgical education publications than SS journals (2.9% [IQR 1.7-4.8%] vs 0.5% [IQR 0.0-1.4%] p < 0.01). Additionally, no significant differences were found for number of surgical education publications when journals were categorized by IF (p > 0.05). Education research is an important component of the surgical literature, with similar publication rates among journals of different impact factors. Publication volume is higher among general surgery than surgical subspecialty journals. With the ever-changing paradigm of surgical training, a rigorous scientific approach is needed to ensure effective training of future surgeons. Subspecialty journals should promote surgical education research to further understand and develop training in their field.

O54: GENDER REPRESENTATION IN EDITORIAL BOARDS OF INTERNATIONAL GENERAL SURGERY JOURNALS

Abstract Introduction Despite women constituting over half of new UK doctors, and a similar proportion worldwide, gender disparity remains an issue throughout academic medicine. Surgery has shown particularly slow progress towards gender parity. This study aims to quantify gender representation within editorial boards of the top 25 general surgical journals. Method All surgical journals were collated using the SCImago Journal Rank (SJR) and Journal Impact Factor (JIF). Non general surgery journals were excluded. Journals were contacted requesting gender editorial team demographics. Editorial board data was collected via journal websites on 20th November 2019. Result The top 25 surgical journals were determined through SJR and JIF ranking methods. Editorial board data was publicly available for 31 of these 32 different surgical journals. This data was then examined. Women accounted for 18.4% (576/3135) of total editorial board positions. Women constituted 12.5% (5/40) of Editors-in-Chief positions, 31.6% (31/98) of Deputy Editors and 17.2% (416/2415) of general editorial board positions. Conclusion For the first time, gender disparity has been demonstrated within editorial boards of the most prominent general surgery journals. The implications of such significant gender disparity are wide reaching. Action should be taken to champion fair female representation, eliminate risk of bias and provide more visible female role models in academic surgery. Take-home message For the first time, this study demonstrates gender disparity in Editorial boards of major general surgery journals. Action should be taken to champion fair female representation, eliminate risk of bias and provide more visible female role models in academic surgery.

Gender representation in editorial boards of international general surgery journals.

BackgroundDespite women constituting over half of new doctors, gender disparity remains an issue. Surgery has shown particularly slow progress towards gender parity. This study aimed to quantify gender representation within editorial boards of the highest ranking international general surgery journals.MethodsSurgical journals were collated using two indices: SCImago Journal Rank (SJR) and Journal Impact Factor (JIF). Non-general surgery journals were excluded. Journals were contacted, requesting gender editorial team demographics. Editorial board data were collected via journal websites on 28 November 2019.ResultsThe top 25 general surgery journals according to SJR and JIF ranking methods were determined, identifying 28 unique journals. Editorial board data were publicly available for 27 of these 28 surgical journals, and were examined. Women accounted for 20.2 per cent (568 of 2816) of total editorial board positions. Women constituted 11 per cent (4 of 36) of editor-in-chief positions, 32 per cent (29 of 92) of deputy editors, and 19.1 per cent (369 of 1935) of general editorial board positions.ConclusionThe findings demonstrate gender disparity within editorial boards of the most prominent general surgery journals.

Conflicts of Interest in Studies Related to Mesh Use in Ventral Hernia Repair and Abdominal Wall Reconstruction.

To examine the accuracy of the reporting of conflicts of interest (COI) among studies related to mesh use in ventral hernia repair and abdominal wall reconstruction. Accurate declaration of COI is integral to ensuring transparency of study results. Multiple studies have demonstrated undeclared COI are prevalent in surgical literature. Studies with at least 1 American author accepted between 2014 and 2018 in 12 major, peer-reviewed general surgery and plastic surgery journals were included. Declared COI were compared with payments listed in the "Open Payments" database [maintained by the Centers for Medicare & Medicaid Services (CMS)] during the year of acceptance and 1 year prior. Studies and authors were considered to have a COI if they received payments from any of 8 major mesh companies totaling >$100.00 from each company. Risk factors for undeclared COI were determined at the study and author levels. One hundred twenty-six studies (553 authors) were included. One hundred two studies (81.0%) had one or more authors who received payments from industry and inaccurately declared their COI. Two hundred forty-eight authors (44.8%) did not declare their COI accurately. On multivariate analysis, last authors were found to be at highest risk for undeclared payments (OR 3.59, 95%CI 2.02-6.20), whereas middle authors were at significantly higher risk for undeclared payments than first authors (OR 1.64, 95%CI 1.04-2.56). The majority of studies investigating the use of mesh in ventral hernia repairs and abdominal wall reconstructions did not accurately declare COI. Last authors are at highest risk of undisclosed payments. Current policies on disclosing COI seem to be insufficient to ensure transparency of publications.

We Are What We Write: 133 Years of History in 4 Surgical Journals.

The profession of surgery has long purported to value its history. This study evaluates that interest by calculating the percent of historical articles in 4 major general surgery journals from 1885 to 2018 (Annals of Surgery; Surgery, Gynecology, and Obstetrics; American Journal of Surgery; and Archives of Surgery). Of all articles published over the last 133 years, 1.65% focused on history, although this percentage fluctuated between 0% and 4.77%. A peak in the 1920s likely both represents and buttresses a national movement to elevate and professionalize the field of surgery. A plurality of the articles were biographical. The proportion of history articles in these journals has been declining of late due to reasons such as the proliferation of periodicals and impact factor considerations. The new Annals of Surgery-Open promises an ideal forum to publish this work, celebrate our heritage, and study the history of who we are as surgeons.

Factors Associated With the Highest and Lowest Cited Research Articles in General Surgery Journals

BackgroundCitation count is a common bibliometric tool used to determine the long-term impact and performance of journal articles. Many of the other potential factors associated with highly and lowly cited articles in the general surgery literature, however, remain unknown. The purpose of this study was to attempt to identify characteristics of articles that may predict or correlate with article citation counts and, consequently, article impact. MethodsWe identified articles from Annals of Surgery, British Journal of Surgery, and Journal of the American College of Surgeons between 1998 and 2008 that had 0-5 total citations. We then matched these articles to an identical number of the highest cited articles from these same journals for comparison. Student's t-tests, Wilcoxon rank-sum tests, chi-squared tests, and Fisher's exact tests were used to determine the significance of difference between data sets at a predetermined level of significance set to P < 0.05. ResultsSignificant differences of article characteristics between the two cohorts included higher prevalence of clinical studies (P = 0.3919), multi-institutional (P = 0.0007) and multi-national (P = 0.0023) studies, surgical oncology (P < 0.0001) or hepatobiliary focus (P < 0.0001) and published in Annals of Surgery (P < 0.0001) for the highly cited cohort. Highly cited articles were also more likely to have larger sample sizes (P = 0.0009), more authors (P < 0.0001), presence of statistically significant results (P < 0.0001), more references (P < 0.0001), more tables (P < 0.0001), more figures (P = 0.0001), and higher word counts for manuscript (P < 0.0001), abstract (P < 0.0001), and title (P < 0.0001). ConclusionsThere are a relatively small number of articles with 0-5 citations after 10 y for these major general surgery journals. This indicates that journals are consistently able to select articles that will be impactful in aiding future research. Certain factors, however, are associated with being highly cited as opposed to lowly cited, and an understanding of these factors can aid researchers and journals in designing and reporting future studies.

Examining the Correlation Between Altmetric Score and Citations in the General Surgery Literature

BackgroundWith the emergence of social media platforms, new bibliometric profiles measuring impact and exposure of scientific research online have been introduced as an alternative to traditional bibliometric outcomes. The objective of this article is to evaluate relationships between Altmetric scores, journal impact factor, and citation counts among the surgical literature. MethodsWe analyzed the top 10 highest cited articles for the 10 general surgery journals with the highest impact factors for 2013 and 2016 by noting citation counts and Altmetric scores for each article. We also identified the journal impact factor and age of journal associated Twitter accounts. Variables were assessed for correlation using Pearson’s correlation testing via Microsoft Excel. ResultsA total of 240 articles were analyzed. For 2013, Altmetrics score analysis demonstrated a significant, positive correlation with citation number (r = 0.462, P < 0.0001) and journal impact factor (r = 0.439, P < 0.0001). The 2016 cohort also demonstrated significant, positive correlations between Altmetric scores and citation count after the removal of one outlier (r = 0.182, P = 0.047) and journal impact factor when considering all articles (r = 0.425, P < 0.0001). From 2013 to 2016, the total number of citations for all articles decreased from 11,027 to 7661, but cumulative Altmetric scores increased from 1078 to 4782. Age of creation for a journal’s Twitter account did not significantly affect Altmetric score or traditional bibliometric measures in either 2013 (r = 0.370, P = 0.293) or 2016 (r = 0.441, P = 0.202). ConclusionsAltmetric scores, while significantly associated with citation count in the surgical literature, should not necessarily be used as a surrogate marker for evaluating research performance, impact, or exposure. It is possible, however, that as the use of social media for distributing and sharing scientific research continues to expand, that exposure on such platforms could impact future interest or studies.

Protocol for a systematic review of reporting standards of anaesthetic interventions in randomised controlled trials

IntroductionThere is significant variation in how anaesthesia is defined and reported in clinical research. This lack of standardisation complicates the interpretation of published evidence and planning of future clinical trials....

Canine Assault with Blunt Trauma to the Chest Causing Acute Ischemic Stroke

Ischemic stroke occurs in a significant subset of patients with blunt traumatic cerebrovascular injury (TCVI). The patients are most often victims of motor vehicle crashes or assaults, and suffer ischemic stroke due to injury of the extracranial carotid or vertebral arteries. A 60 year old male described walking in a park when a large dog jumped up striking him in the chest and causing forceful rotation of the neck, but no head injury was reported. Immediately after the incident the patient complained of dizziness, clumsiness of the left arm, and difficulty seeing to the left. Computed tomography angiography of the neck demonstrated 50% stenosis of the proximal right internal carotid artery secondary to mural thrombus. Prior to the event the patient had no known history of carotid disease. Magnetic resonance imaging of the brain showed numerous subcentimeter foci of acute ischemia in the right cerebral hemisphere within the right middle and posterior cerebral artery distributions. Most literature about TCVI and stroke has been published in trauma, general surgery, and neurosurgery journals because these patients are generally primarily managed by trauma surgeons. Because of the increasing prevalence and awareness of TCVI, it is important to bring this clinical entity to the attention of all medical providers.