Publications on paediatric anaesthesia: a quantitative analysis of publication activity and international recognition

A. M. Brambrink*, D. Ehrler and W. F. Dick

Department of Anaesthesiology, University Hospital, Johannes Gutenberg-University, Langenbeckstrasse 1, D-55131 Mainz, Germany

Accepted for publication: May 16, 2000


    Abstract
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
A comprehensive compilation of the current international literature on paediatric anaesthesia is lacking. The aim of this study was to identify all articles on clinical practice in paediatric anaesthesia, to name the respective journals, and to assess the publication activity and international recognition of selected countries for a 6-yr period (1993–1998). The search comprised an article-to-article evaluation (‘hand search’) of 12 peer-reviewed anaesthesia journals, as well as an Internet-based (‘SilverPlatter’) MedlineTM-search (3.900 medical journals, US National Library of Medicine), both limited to original articles, case reports, reviews and editorials. Selected physical characteristics, for example the number of infants and children aged 0–14 yr old, the number of anaesthetists (specialists) and current impact factors (Science Citation Index) served to assess publication activity and international recognition. During the time period studied, 2259 articles (377/yr) were published on paediatric anaesthesia in 295 medical journals. The articles were primarily written in English (85.1%) and the majority originated from the USA (35.4%) and the UK (12.6%). The largest number of publications (77.7%) appeared in 29 anaesthesia journals, all referenced in MedlineTM, with 46% being published by only five journals. Most authors published in journals of their home country/region. Authors from the UK ranked highest in publication activity, followed by those from Canada, Switzerland, Sweden and Denmark. The highest impact factor was achieved by US and UK authors. We conclude that publications on paediatric anaesthesia are clustered in a small number of journals and are written predominantly by authors from English-speaking countries, who achieved the highest international recognition.

Br J Anaesth 2000; 85: 556–62

Keywords: anaesthesia, paediatric; publications


    Introduction
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
Interest in paediatric anaesthesia has been growing steadily in recent years and many specialists dedicate a large share of their professional activity to this field. Special societies for paediatric anaesthesia or sections within national anaesthesia councils are involved in developing guidelines for the practice of, and continuing education in, paediatric anaesthesia. In 1997, the US-Accreditation Council for Graduate Medical Education (ACGME) acknowledged the fellowship program for paediatric anaesthesia.1

New medical information is communicated through international journals. The number of articles on specific topics such as paediatric anaesthesia, indicates current publication activity in the respective field. In addition to information transfer, peer-reviewed publication activity contributes to the visibility of individual authors within the medical community, and publications in highly ranked journals may promote their professional career as well as the likelihood of receiving funding from various sources.2

Our literature search failed to identify a quantitative evaluation of the spectrum of publications, authors and journals on paediatric anaesthesia. It was therefore the aim of this study to identify: all papers with a focus on anaesthesia in infants and children published over a 6-yr period; the respective journals; the publication activity and the international recognition achieved (according to impact factors) of the authors who were from several countries; and to characterize the publication patterns.


    Methods
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
Data collection
The key words were selected either according to the subject (child, children, infant(s), baby, newborn, neonate(s), p(a)ediatric(s), p(a)ediatric an(a)esthesia) or to typical situations, procedures or problems, and environments in paediatric anaesthesia (an(a)esthesia, analgesia, an(a)esthetic(s), intubation, postoperative pain, pain therapy, postan(a)esthesia care unit, postsurgical intensive care). The search was limited to original articles, case reports, reviews and editorials. It excluded letters to the editor, historical articles, reports of meetings and abstracts. The study period was 1993–1998.

Twelve peer-reviewed serial publications in the field of anaesthesia (Acta Anaesthesiologica Scandinavica [1 volume/ 10 issues per year], Anaesthesia [1/12], Anästhesiologie-Intensivmedizin-Notfallmedizin-Schmerztherapie [1/8 in 1993–1995, 1/10 in 1996, 1/12 in 1997–1998], Anesthesia & Analgesia [2/12], Anesthesiology [2/12], British Journal of Anaesthesia [2/12], Canadian Journal of Anaesthesia [1/12], Der Anaesthesist [1/12], European Journal of Anaesthesiology [1/6], Paediatric Anaesthesia [1/6; 1/7 in 1997], Pain [4/12; 5/15 in 1996–1998], Regional Anesthesia, 1998 renamed Regional Anesthesia and Pain Medicine [1/6]) were evaluated on an article-to-article basis (‘hand search’3 4). The annual number of articles was determined for each journal and the abstracts were searched for the selected key words. If one of the key words was identified, the publication was registered and the first page archived. The annual subject index of every periodical was also cross-checked for all key words to ensure identification of each article on paediatric anaesthesia.

The MedlineTM database was searched by PC (WinSPIRS 2.0, SilverPlatter Information, Boston, USA). Boolean operations were used (variables were the selected key words and year of publication; the above-mentioned 12 periodicals were excluded). The computerized search allowed key word identification in the title, abstract, Medical Subject Headings (MESH), and address of origin. The MedlineTM report was archived for each identified contribution, including the abstract and address of the authors.

Study selection
English abstracts of all initially identified articles were assessed for clinical practice of paediatric anaesthesia. Articles related to other fields of medicine, for example surgery, cardiology, immunology or experimental research, were excluded from further evaluation. Thus, a detailed report on endoscopic findings in children anaesthetized during the procedure was excluded. In contrast, a publication describing certain paediatric anaesthesia techniques during endoscopic procedures was included.

Formal analysis
The final sample was evaluated as to language and country of origin. The origin of publications was determined according to the following algorithm: (i) address of correspondence; (ii) address of the institution; or (iii) nationality of the first author shown in previous publications by the same individual. If more than one address was indicated, the first one was used.

Physical characteristics, ranking and calculations
Numbers (1993–1998) of infants and children (aged 0–14 yr) and officially registered anaesthetists (specialists) were calculated and averaged, based on information provided by governments and national specialist societies of selected countries. The numbers of publications per 1 million children (PpmC; potential study population) and publications per 1000 anaesthetists (PptA; potential investigators) were determined by dividing the total number of relevant publications by the respective demographic factor.

It may be assumed that the number of publications together with the respective cumulative impact factor may serve to assess publication activity of a specific journal and of a country/region. Anaesthesia journals referenced in MedlineTM were listed according to the number of articles on paediatric anaesthesia published during the 6-yr study period, and the respective impact factor (Science Citation Index) was averaged from 1993 to 1998.5 The cumulative impact factor for a journal (cIF-journal) resulted from the multiplication of the number of articles therein by the respective impact factor. The cumulative impact factor for a country (cIF-country) was calculated for the seven most active countries/regions (number of articles) by adding the respective cIF-journal values of the national authors. Additionally, the mean impact factor (mIF) for the average publication on paediatric anaesthesia was obtained for each of these countries by dividing cIF-country by the number of publications for each country.


    Results
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
We identified 2259 publications on paediatric anaesthesia in 295 peer-reviewed journals for the years 1993–1998 (377/yr). More than 58% (n=1325) were published in 12 anaesthesia journals, and represent 8.7% of the total number of articles published therein (n=15 268, ‘hand searched’). A search of the MedlineTM database yielded 934 articles published in 283 journals (initially 3135 in 590 journals). The articles were predominantly written in English (85.1%; Table 1) and originated in the USA or the UK (12.6% and 35.4%, respectively; Table 2).


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Table 1 Language of publication
 

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Table 2 Origin of publication (according to the address of correspondence)
 
With reference to PptA and PpmC (Table 3), authors from the UK published the largest number of articles (94.7 PptA; 28.3 PpmC), followed by those from Canada (77.4; 28.9), Switzerland (47.7; 30.3), Sweden (32.8; 27.9) and Denmark (30.9; 28.4). Considering the available manpower (anaesthetists) and the size of the potential study population (infants and children), authors from the USA (24.7; 14.0), Japan (24.1; 8.6), Germany (8.4; 10.0) and Italy (5.2; 5.6) published a relatively smaller number of articles.


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Table 3 Demographic data and analysis of publication activity on paediatric anaesthesia for selected countries1US Department of Commerce, Economics and Statistics, Bureau of the Census, Washington DC, USA. 2Office for National Statistics, London, UK. 3Statistics Canada, Ottawa, Ontario, Canada. 4Foreign Press Center, Tokyo, Japan. 5Statistisches Bundesamt, Wiesbaden, Germany. 6Institute Nationale de Statistique et des Études Economiques, Paris, France. 7Istituto nazionale di statistica, Rome, Italy. 8Australian Bureau of Statistics, Belconnen, Australia. 9Statistiska centralbyrån-Statistics Sweden, Stockholm, Sweden. 10Bundesamt für Statistik, Sektion Information, Bern, Switzerland. 11Central Bureau for Statistics, Den Haag, Denmark. 12Centraal Bureau voor de Statistiek, Voorburg, The Netherlands. 13Österreichisches Statistisches Zentralamt, Wien, Austria. 14Best possible estimate by the Japanese Medical Society, Sapporo Local Area Medical Network. *Listed according to the number of publications on paediatric anaesthesia during 1993–1998 (n=1910, other countries=349). #Number of infants and children (0–14-yr-old, mean value for 1993–1998). $Anaesthetists (‘specialists’), mean value for 1993–1998. CpA, children per anaesthetist; PptA, publications per thousand anaesthetists; PpmC, publications per million children.
 
The annual number of publications on paediatric anaesthesia in the 12 hand-searched periodicals increased by 23.7% (from 194 to 240) from 1993 to 1998 (Table 4). For some journals, for example Anesthesia & Analgesia and Paediatric Anaesthesia, the increase was significantly greater (+80%: from 25 to 45; and +54%: from 61 to 94, respectively), whereas in others, for example Canadian Journal of Anaesthesia and Masui (Japan), there was a decrease over the same period (–86%: from 26 to 14; and –79%: from 28 to 6, respectively).


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Table 4 Number of annual publications on paediatric anaesthesia in 12 ‘hand-searched’ journalsPA, Paediatric Anaesthesia; A&A, Anesthesia & Analgesia; CJA, Canadian Journal of Anaesthesia; BJA, British Journal of Anaesthesia; ANSLY, Anesthesiology; ANSIA, Anaesthesia; AAS, Acta Anaesthesiologica Scandinavica; D-ANAE, Der Anaesthesist; AINS, Anaesthesiologie-Intensivmedizin-Notfallmedizin-Schmerztherapie; EJA, European Journal of Anaesthesiology; RA, Regional Anesthesia.
 
A total of 77.7% of all publications appeared in 29 anaesthesia journals listed in MedlineTM (Table 5). Others were found in journals for various medical disciplines, for example surgery, intensive care medicine, emergency medicine, hygiene. Most articles (n=1350; 59.8%) were published in 15 serial anaesthesia journals from four English-speaking countries, that is USA (9), UK (4), Australia (1) and Canada (1), and ~ 46% (n=1041) in a total of five journals (Paediatric Anaesthesia, Anesthesia & Analgesia, Canadian Journal of Anaesthesia, British Journal of Anaesthesia and Anesthesiology). One-fifth of the articles (n=428; 18.9%) were published in the journal Paediatric Anaesthesia. The difference in the impact factor of the cited journals resulted in a different ranking of the cIF-journal. For example, the cIF-journal of some periodicals was high despite the relatively smaller number of publications during the study period (e.g. Anesthesiology, cIF-journal=559.26; n=121), compared with that of journals publishing a greater number of articles (e.g. Paediatric Anaesthesia, cIF-journal=347.97; n=428).


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Table 5 Publications on paediatric anaesthesia in 29 anaesthesia journals listed in MedlineTMFor each journal the total number of publications on paediatric anaesthesia (n, [1993–1998]), the respective percentage of all identified publications (%), the mean impact factor (1993–1998, ranking), as well as the respective cIF-journal (ranking) are listed. *Listed by the number of publications on paediatric anaesthesia during 1993–1998. # No impact factor available, journal not listed in ‘Science Citation Index’ (ISI).5 §Until 1996 published as ‘Regional Anesthesia’. +No impact factor listed for the years 1993–1995. $No impact factor listed for the years 1993–1994. IF, impact factor; cIF-journal, cumulative impact factor for a journal (={[n] multiplied by [IF]}); F, France; UK, United Kingdom; G, Germany; NA, not available.
 
Most authors have published their work in anaesthesia journals of their respective country or region (Table 6). Similarly, the majority of periodicals was dominated by national authors, for example 64.9% of the articles in US journals were of US origin (n=336). This was found even more frequently in journals from non-English-speaking countries, for example Japan, France or Germany. However, British and Canadian periodicals, for example Paediatric Anaesthesia, Canadian Journal of Anaesthesia, showed a greater diversity in authorship. More international representation in authorship was identified for journals published in English.


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Table 6 Publications on paediatric anaesthesia from the seven most active countries (see Table 2) in 29 anaesthesia journals listed in MedlineTM (see Table 5)*Listed by the number of publications on paediatric anaesthesia during 1993–1998 [journals with no impact factor (‘Science Citation Index’, SCI5) are not included in this table]. n, number of publications on paediatric anaesthesia; IF, impact factor; cIF-j, cumulative impact factor for a journal (={[n] multiplied by [IF]}); cIF-country, cumulative impact factor for a country (={addition of all individual [cIF-j] for each country}); F, France; UK, United Kingdom; G, Germany; Scand., Scandinavia.
 
The cIF-country (Table 6) was higher for publications by US authors (1084.41), followed by the work of British (353.38) and Canadian groups (297.04). Accordingly, the calculated mIF-country was high for North American and British authors. However, publications from Scandinavia also achieved a high mIF-country (Table 7).


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Table 7 Mean impact factor of publications on paediatric anaesthesia*Listed by the number of publications on paediatric anaesthesia from 1993 to 1998 (see Table 5). §mIF={[cumulative IF-country, see Table 6] divided by [all publications in anaesthesia journals of the same country, (including articles in those journals, for which no impact factor was available; see Table 5)]}
 

    Discussion
 Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
General findings
There was a mean of 377 publications published each year on paediatric anaesthesia and most of the papers were written in English. The largest number of articles appeared in Paediatric Anaesthesia, Anesthesia & Analgesia, the Canadian Journal of Anaesthesia, the British Journal of Anaesthesia and Anesthesiology. British authors published most articles on the topic in relation to selected physical characteristics (e.g. age of the children and infants). Most work originated from the USA and the UK. These articles were also published in the journals with the highest impact factors in the field, resulting in high international recognition.

Limitations and advantages of the applied method
The limitations of this exercise were that MedlineTM (US National Library of Medicine, 1999) only references 3900 of ~165 000 published journals worldwide.6 Furthermore, we excluded book chapters, abstracts, popular science publications or rejected manuscripts, all of which reflect publication activity. The advantages of this restrictive approach were that all included articles underwent peer-review ensuring a specific level of quality, and that subjective or random factors such as accessibility were eliminated making the results reproducible. Furthermore, because only work on ‘clinical’ paediatric anaesthesia was included in our study, some publications with potentially relevant information may not have been identified.

The selection of key words and the criteria for inclusion or exclusion of the retrieved articles was dependent upon the decision of the investigators. Other search terms or selection criteria might have yielded different data. In addition, as the correspondence address listed may not always have represented the country of origin of all the authors involved, we were unable to quantify foreign contributions to specific papers.

Journals
Approximately 78% of all publications appeared in anaesthesia journals, and 46% of the articles were found in five periodicals (Paediatric Anaesthesia, Anesthesia & Analgesia, Canadian Journal of Anaesthesia, British Journal of Anaesthesia and Anesthesiology). While these journals may be of vital interest to paediatric anaesthetists worldwide, other anaesthesia journals may also be important, because for instance they reflect activities in the country of the respective reader.

Increases in the number of articles on paediatric anaesthesia (24%) were smaller than increases in publications on medical topics as a whole (33%).6 Larger or smaller increases in some journals may be a reflection of editorial board decisions. For example, Anesthesia & Analgesia became the official journal of the ‘American Society of Pediatric Anesthesia’ in 1996,1 and the number of publications on paediatric anaesthesia increased accordingly. This may have led to fewer publications elsewhere, for instance in the Canadian Journal of Anaesthesia or in Masui. Alternatively, the impact factor of a journal (e.g. Anesthesia & Analgesia, IF=2.471; Table 5) could play an important role in manuscript submission. Some authors, for instance from Japan, may have preferred to submit their manuscripts there, which in turn, resulted in fewer submissions to Japanese journals.

Paediatric Anaesthesia has an important position with ~19% of all publications in the field, although the impact factor (0.813) is ranked relatively low. The relevance of the impact factor to estimate importance and quality of scientific output has become the subject of intense debate.715 It has been suggested that the impact factor reflects international recognition or ‘visibility’, rather than the quality or importance of certain periodicals or a researcher’s work.16 Some journals may have an important role independent of their impact factor as they convey specific information for interested specialists.

Publication productivity and international recognition of different countries/regions
The largest proportion of publications on paediatric anaesthesia originated from the USA and the UK, which is in proportion to medical research output in general.6 American and British authors may publish more frequently, due to special mechanisms of fund-raising and career development in their home countries. The high productivity of anaesthetists from the UK and several smaller European countries, Switzerland, Sweden, Denmark, was to be expected as it is similar to the publication pattern in other medical areas.4 1719 Differences in publication productivity between countries have been associated with differences in the respective medical systems and other factors such as language, training and funding.17

Alternatively, work from highly productive countries may have been published preferentially. A strong correlation between the origins of medical journals and the respective authors has previously been observed in related fields, for example anaesthesia, intensive care, emergency medicine and pain management.14 18 19 Apart from the scientific content, which is evaluated through a vigorous peer-review process, it has been suggested that acceptance of manuscripts may be influenced by various co-factors. For example, the probability of having an English language manuscript accepted is greater than the acceptance of a non-English version.20 Furthermore, the majority of authors publishing in highly ranked USA- or UK-based journals write in their native language, originate from countries with a high scientific reputation, and their reviewers may be from the same country. Thus, it has been suggested that work by Anglo-American authors is more likely to be accepted by Anglo-American journals, resulting in a certain publication bias.2124

Some of these factors may exert an additional influence on publication patterns in paediatric anaesthesia. However, our data appear to support the view that anaesthetists from certain countries, in relation to the respective available manpower and/or study population, are more active in communicating new information on paediatric anaesthesia to the scientific community. Together with the higher impact factors of the journals, this results in higher cumulative and mean impact factors for both North American and British publications, and thus in greater international recognition or ‘visibility’ (i.e. number of publications multiplied by the impact factor).16 The high cumulative and mean impact factors of some European countries/regions, may additionally result from the lack of non-English language anaesthesia journals in these countries, leading the authors to publish elsewhere.

In conclusion, Paediatric Anaesthesia, Anesthesia & Analgesia, the Canadian Journal of Anaesthesia, the British Journal of Anaesthesia and Anesthesiology are important journals for the paediatric anaesthetist, as they account for ~46% of all publications in this field. Publications on paediatric anaesthesia with the greatest international recognition (according to the impact factor) originated from the US and the UK. This may be due to a high publication productivity of authors from the respective countries, and certain co-factors supporting publication in the highly ranked USA- and UK-based periodicals. The ‘lingua franca’ of scientific publications is English, a factor that cannot be ignored by non-native speakers of English who wish to influence paediatric anaesthesia.


    Acknowledgement
 
This work contains preliminary data from the doctoral dissertation (MD) of D.E.


    Footnotes
 
* Corresponding author Back


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 Abstract
 Introduction
 Methods
 Results
 Discussion
 References
 
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