METHOD: This was an observational study of adults aged 50 years and over admitted to hospital over 12 months with an acute vertebral fragility fracture. Information was collected from patients and electronic health records on their presentation and hospital care.
RESULTS: 90 patients were recruited into the study. 69% presented to hospital 24 h after the onset of their severe acute back pain. 38% had a concomitant medical diagnosis, such as an ongoing infection. X-ray of the spine was the most common imaging of choice to diagnose a fracture. There was variation in the content of the radiology reports. 46% or patients were managed on geriatric medicine wards, 39% on general medical wards, and followed by 14% on spinal surgical wards. Patients cared for by medical teams were older, frailer, had a higher prevalence of cognitive impairment, more dependent for daily living and less mobile compared to those under the care of the spinal surgical team. Many patients on medical wards had input from spinal surgical team and vice versa. 9% proceeded to have vertebral augmentation. Despite many in severe pain, only a third were prescribed opioids with the median dose of morphine-equivalent was 10-20 mg daily for the first three days of admission. While in hospital, 31% developed a medical complication, with infection being the most common one. On discharge, 76% still required opioids and only 56% had a plan for their bone health.
DISCUSSION: Improvements could be made to hospital vertebral fracture care. Many did not receive adequate pain relief and appropriate assessments to reduce their future fall and fracture risk. Most were medically managed. Quality standards and re-organising care in hip fracture has led to improved outcomes. A similar approach in vertebral fragility fractures might also deliver improved outcomes.
METHODOLOGY: The Clarivate Analytics' Web of Science 'All Databases', Elsevier's Scopus, Google Scholar and PubMed Central were searched to retrieve the 50 most-cited articles in the IEJ published from April 1967 to December 2018. The articles were analysed and information including number of citations, year of publication, contributing authors, institutions and countries, study design, study topic, impact factor and keywords was extracted.
RESULTS: The number of citations of the 50 selected papers varied from 575 to 130 (Web of Science), 656 to164 (Elsevier's Scopus), 1354 to 199 (Google Scholar) and 123 to 3 (PubMed). The majority of papers were published in the year 2001 (n = 7). Amongst 102 authors, the greatest contribution was made by four contributors that included Gulabivala K (n = 4), Ng YL (n = 4), Pitt Ford TR (n = 4) and Wesselink PR (n = 4). The majority of papers originated from the United Kingdom (n = 8) with most contributions from King's College London Dental Institute (UK) and Eastman Dental Hospital, London. Reviews were the most common study design (n = 19) followed by Clinical Research (n = 16) and Basic Research (n = 15). The majority of topics covered by the most-cited articles were Outcome Studies (n = 9), Intracanal medicaments (n = 8), Endodontic microbiology (n = 7) and Canal instrumentation (n = 7). Amongst 76 unique keywords, Endodontics (n = 7), Mineral Trioxide Aggregate (MTA) (n = 7) and Root Canal Treatment (n = 7) were the most frequently used.
CONCLUSION: This is the first study to identify and analyse the top 50 most-cited articles in a specific professional journal within Dentistry. The analysis has revealed information regarding the development of the IEJ over time as well as scientific progress in the field of Endodontology.