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J Bone Joint Surg Am. 2010 May;92(5):1155-61. doi: 10.2106/JBJS.I.00063.

Reference accuracy in peer-reviewed pediatric orthopaedic literature.

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Shriners Hospital for Children, Greenville, SC 29605, USA.



Reference accuracy of articles published in the biomedical literature is determined by the presence of citation and quotation errors. A recent review demonstrated that the median citation error rate per biomedical journal was 39%, and the median quotation error rate per journal was 20%. Reference accuracy in pediatric orthopaedic articles has not been previously reported, to our knowledge.


Two hundred references from twenty articles published in four peer-reviewed orthopaedic journals were randomly selected for assessment of citation and quotation accuracy. Full-text copies of all original references were obtained by interlibrary loan methods and reviewed directly to establish citation accuracy. The presence of citation errors was determined by a single investigator. The relevance of citation errors was determined by assessing the ease of reference retrieval through PubMed. Quotation accuracy was determined by two examiners who reviewed each of the twenty articles and 200 references to compare the claims made for the references in the article against the data and opinions expressed in the actual reference.


The total citation error rate across all of the journals was 26% (fifty-one of 200 references) with a 95% confidence interval of 16.5% to 37.3%. The median citation error rate per journal was 27% (range, 10% to 38%). Although citation errors were common, most were of minimal significance, as 196 of the 200 references could be retrieved with ease from PubMed. The total quotation error rate across all of the articles was 38% (152 of 398 reference citations) with a 95% confidence interval of 30.1% to 47.0%. The median quotation error rate per journal was 38% (range, 28% to 46%).


Citation and quotation errors are common in the pediatric orthopaedic literature. Reference accuracy continues to be a substantial problem in the biomedical literature despite recent technological advances such as online databases, easily accessible search engines, and widely available bibliographic software.

[Indexed for MEDLINE]

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