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Introduction: Historically musculoskeletal injury has substantially affected United States (US) service members. Lumbosacral spine injuries are among the most common sites of injury for service members across all US military branches and usually presents with pain in the lower back and extremities. The aim of this study is to identify and describe the 50 most-cited articles relevant to military medicine on the subject of the spine. Methods: In April 2020 Web of Science was used to search the key words: spinal cord injury, spine, thoracic spine, lumbar spine, cervical spine, sacrum, sacral, cervical fusion, lumbar fusion, sacral fracture, combat, back pain, neck pain, and military. Articles published from 1900 to 2020 were evaluated for relevance to military spine orthopaedics and ranked based on citation number. The 50 most-cited articles were characterized based on country of origin, journal of publication, affiliated institution, topic, military branch, and conflict. Results: 1900 articles met search criteria. The 50 most-cited articles were cited 24 to 119 times and published between 1993 and 2017. 30 articles (60%) originated in the United States. Aviation, Space, and Environmental Medicine accounted for the most frequent (n = 10) destination journal followed by Spine (n = 8). 37 institutions contributed to the top 50 most-cited articles. The most common article type was clinically focused retrospective analysis 36% (n = 18), clinically focused cohort study 10% (n = 5), and clinically focused cohort questionnaire, cross-sectional analysis, and randomized study 8% each (n = 4). 90% of articles were non-surgical (n = 45). The US Army had the greatest number of associated articles. Operation Iraqi Freedom and Operation Enduring Freedom were the most-cited conflicts. Conclusion: The 50 most-cited articles relevant to military spine orthopaedics are predominantly clinically focused, arising from the US, and published in Aviation, Space, and Environmental Medicine, Spine, and The Spine Journal.
RESUMO
Purpose: To evaluate the peer-reviewed orthopaedic sports medicine literature for reference errors within 2 high-impact journals. Methods: In total, 769 references with 1,082 in-line citations were assessed from 20 randomly selected peer-reviewed articles published in 2 high-impact orthopaedic sports medicine journals, Arthroscopy and the American Journal of Sports Medicine. Full-text copies of references were obtained through online literature subscription databases. Two investigators evaluated each citation for agreement between the reference's study design, methods, data, discussion, and conclusion with the citing authors' claims. Error rates, interobserver agreement, and association between error rates and journal demographics were assessed. Results: Cohen's κ coefficient representing interobserver agreement was 0.61. The mean citation error rate across 20 articles from 2 orthopaedic sports medicine journals was 6.6%. The most common error was failure to support the authors' assertions within the citing article, accounting for 32% of errors. There was no significant association between error rate and journal impact factor, number of cited references or total references, ratio of in-line citations to cited references (citation ratio), and number of authors. There was no significant relationship between error rate and journal, study type, and level of evidence. Conclusions: Inaccurate claims and citations are common within the orthopaedic sports medicine literature, occurring in every reviewed article and 6.6% of all in-line citations. Failure to support the assertions of the article in which a reference is cited is a common error. Authors should take care to rigorously assess references with particular attention to accurate citation of primary sources. Clinical Relevance: This study highlights the prevalence of citation errors within a random sampling of high-level orthopaedic sports medicine articles. Given science is cumulative, these errors perpetuate inaccuracies and are at odds with evidence-based practice.
