Landmark

What makes a landmark article?

Landmark is hard to define, but we seem to know it when we see it.  Certain articles are of such importance, that our daily practice will not be the same after reading it.  Here is how I define "landmark."

  • It is frequently read, quoted, discussed, and cited by others.
  • It is methodologically sound.
  • It may challenge long-held dogma.
  • It may significantly change the way we practice.
  • It stands the test of time in its truth and relevance.
  • It is published by trustworthy authors.
  • It is published in a trustworthy journal.

Of all these items, some are quantifiable, some are not.  Altmetric scores help us quantify how much early buzz an article is generating via social media, news media, etc.  Citation counts are the gold standard and can be found on Web of Science or Google Scholar.  Authors' reputations are quantifiable via citation counts and are denoted with the "h-score."  Finally, a journal's reputation is quantifiable via Impact Factor (Thomson Reuters) or h5-index/h5-median (Google Scholar).

Ultimately, an article is landmark because you, the reader, say it is.  You read it.  You talk about it.  You quote it.  You cite it.  You review it in journal club.  You lecture about it.  You use it in day to day practice.  You teach it at the bedside.

So how do I pick them?  I look around at several sources to find out what articles others have identified as landmark.  Then I compile the very best, the most important.  Sites used to curate these include Docphin, Wiki Journal Club, Journal Watch, Up to Date, Academic Life in EM, EMCrit, Life in the Fast Lane, The Bottom Line, Colorado Compendium / Denver Health Classics, and EM:RAP.  In the end, it is my opinion which articles were included and which were not.  That is why your feedback is so crucial.  No one is perfect, and no doubt I have missed some things.  Would you take a moment to let me know what's missing?

Journals

This is where it gets fun.  I really enjoy this stuff!  Choosing the best current Articles that Matter is a three step process.

1. Finding the Articles

I use a combination of search strings to find articles in PubMed, limit it to the 31 journals I choose to cover, and pick a date range of articles to review.  Here is the PubMed search string I use, and I owe much to McMaster University Health Information Research Unit.  Brace yourself...

Journals Only

This search string pulls up all the articles from all the journals each month.  The total number of articles in these journals is ~3000 per month.

"Circulation"[Journal] OR "Critical care medicine"[Journal] OR "Critical care (London, England)"[Journal] OR "Intensive care medicine"[Journal] OR "Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies"[Journal] OR "The journal of trauma and acute care surgery"[Journal] OR "Annals of emergency medicine"[Journal] OR "Academic emergency medicine : official journal of the Society for Academic Emergency Medicine"[Journal] OR "The American journal of emergency medicine"[Journal] OR "Emergency medicine journal : EMJ"[Journal] OR "The Journal of emergency medicine"[Journal] OR "Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors"[Journal] OR "Pediatrics"[Journal] OR "Pediatric emergency care"[Journal] OR "The New England journal of medicine"[Journal] OR "Lancet (London, England)"[Journal] OR "JAMA"[Journal] OR "JAMA pediatrics"[Journal] OR "JAMA internal medicine"[Journal] OR "BMJ (Clinical research ed.)"[Journal] OR "Resuscitation"[Journal] OR "Anesthesiology"[Journal] OR "Anesthesia and analgesia"[Journal] OR "Journal of the American College of Cardiology"[Journal] OR "Annals of internal medicine"[Journal] OR "The western journal of emergency medicine"[Journal] OR "Journal of thrombosis and haemostasis : JTH"[Journal] OR "The Lancet. Neurology"[Journal] OR "Neurology"[Journal] OR "The Journal of bone and joint surgery. American volume"[Journal] OR "American journal of respiratory and critical care medicine"[Journal] OR "Chest"[Journal]

Updated 8 June 2017

Limiting the Search

This limits the search to clinical trials, diagnostic, clinical prediction rules, causation, and important reviews.

I use a higher sensitivity, lower specificity approach for all the journals.  This yields >1500 articles per month.  Does it miss some articles?  Maybe.  Do I care?  Not too much.  You won't miss the most important stuff unless you live under a rock.  And if I learn of an article I missed, I will shamelessly include it on this site! Here it is:

("Circulation"[Journal] OR "Critical care medicine"[Journal] OR "Critical care (London, England)"[Journal] OR "Intensive care medicine"[Journal] OR "Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies"[Journal] OR "The journal of trauma and acute care surgery"[Journal] OR "Annals of emergency medicine"[Journal] OR "Academic emergency medicine : official journal of the Society for Academic Emergency Medicine"[Journal] OR "The American journal of emergency medicine"[Journal] OR "Emergency medicine journal : EMJ"[Journal] OR "The Journal of emergency medicine"[Journal] OR "Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors"[Journal] OR "Pediatrics"[Journal] OR "Pediatric emergency care"[Journal] OR "The New England journal of medicine"[Journal] OR "Lancet (London, England)"[Journal] OR "JAMA"[Journal] OR "JAMA pediatrics"[Journal] OR "JAMA internal medicine"[Journal] OR "BMJ (Clinical research ed.)"[Journal] OR "Resuscitation"[Journal] OR "Anesthesiology"[Journal] OR "Anesthesia and analgesia"[Journal] OR "Journal of the American College of Cardiology"[Journal] OR "Annals of internal medicine"[Journal] OR "The western journal of emergency medicine"[Journal] OR "Journal of thrombosis and haemostasis : JTH"[Journal] OR "The Lancet. Neurology"[Journal] OR "Neurology"[Journal] OR "The Journal of bone and joint surgery. American volume"[Journal] OR "American journal of respiratory and critical care medicine"[Journal] OR "Chest"[Journal]) AND (((((((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials as topic[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading])) OR (sensitiv*[Title/Abstract] OR sensitivity and specificity[MeSH Terms] OR diagnos*[Title/Abstract] OR diagnosis[MeSH:noexp] OR diagnostic *[MeSH:noexp] OR diagnosis, differential[MeSH:noexp] OR diagnosis[Subheading:noexp])) OR (search*[Title/Abstract] OR meta analysis[Publication Type] OR meta analysis[Title/Abstract] OR meta analysis[MeSH Terms] OR review[Publication Type] OR diagnosis[MeSH Subheading] OR associated[Title/Abstract])) OR (predict*[Title/Abstract] OR predictive value of tests[MeSH] OR scor*[Title/Abstract] OR observ*[Title/Abstract] OR observer variation[MeSH])) OR (risk*[Title/Abstract] OR risk*[MeSH:noexp] OR risk *[MeSH:noexp] OR cohort studies[MeSH Terms] OR group*[Text Word]))

Updated 8 June 2017

2. Selecting the articles

Next, I loosely follow the McMaster version of article selection as well.  The gist is that I only pick articles that are ready for "prime time" - i.e. studies that are derived and validated, studies that are done properly, and studies with results that matter to emergency physicians.  Ultimately, it is my opinion.  It is important to disclose that.  I try to take a scientific approach and use evidence-based search strategies, but at the end of the day it is one guy's opinion.  Hopefully, it is a good one...

After this step, the number of articles is down to 25-30, or about 1% of all the articles in these journals.

That's a NNR ~100.
(NNR, Number Needed to Read = Total Articles/Articles that Matter)

3. Summarizing the articles

Finally, I write a short attention span summary*.  One way to do this is to use the acronym GURU.

GURU stands for:
Guidance from the past - What is already known about this topic?
Unknown - What is the PICO question?
Results - What are the main findings, especially the NNT?
Upshot - How will this article change practice?

 

*Disclaimer: The goal of EM Topics is not to do in depth analysis on each article (though sometimes I can't help myself).  Rather, it is to make you aware of the most important articles in our field and to summarize them in an accurate but very brief way, like a journal's capsule summary.  You can do a thorough article critique yourself with these tools!  My goal is to filter out the chaff, learn, and share the most important findings from the Articles that Matter in Emergency Medicine.  Whenever I can, I'll try to link to others who do an outstanding job of critiquing the articles and covering them in depth.