ObjectiveAlthough the literature supporting the use of point-of-care ultrasound (POCUS) continues to grow, incomplete reporting of primary diagnostic accuracy studies has previously been identified as a barrier to translating research into practice and to performing unbiased systematic reviews. This study assesses POCUS investigator and journal editor attitudes towards barriers to adhering to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 guidelines.Design, setting, participantsTwo separate surveys using a 5-point Likert scale were sent to POCUS study investigators and journal editors to assess for knowledge, attitude and behavioural barriers to the complete reporting of POCUS research. Respondents were identified based on a previous study assessing STARD 2015 adherence for POCUS studies published in emergency medicine, anaesthesia and critical care journals. Responses were anonymously linked to STARD 2015 adherence data from the previous study. Written responses were thematically grouped into the following categories: knowledge, attitude and behavioural barriers to quality reporting, or other. Likert response items are reported as median with IQRs.Main outcome measuresThe primary outcome was the median Likert score for the investigator and editor surveys assessing knowledge, attitude and behavioural beliefs about barriers to adhering to the STARD 2015 guidelines.ResultsThe investigator survey response rate was 18/69 (26%) and the editor response rate was 5/21 (24%). Most investigator respondents were emergency medicine practitioners (13/21, 62%). Two-thirds of investigators were aware of the STARD 2015 guidelines (12/18, 67%) and overall agreed that incomplete reporting limits generalisability and the ability to detect risk of bias (median 4 (4, 5)). Investigators felt that the STARD 2015 guidelines were useful, easy to find and easy to use (median 4 (4, 4.25); median 4 (4, 4.25) and median 4 (3, 4), respectively). There was a shared opinion held by investigators and editors that the peer review process be primarily responsible for ensuring complete research reporting (median 4 (3, 4) and median 4 (3.75, 4), respectively). Three of 18 authors (17%) felt that the English publication language of STARD 2015 was a barrier to adherence.ConclusionsAlthough investigators and editors recognise the importance of completely reported research, reporting quality is still a core issue for POCUS research. The shared opinion held by investigators and editors that the peer review process be primarily responsible for reporting quality is potentially problematic; we view completely reported research as an integral part of the research process that investigators are responsible for, with the peer review process serving as another additional layer of quality control. Endorsement of reporting guidelines by journals, auditing reporting guideline adherence during the peer review process and translation of STARD 2015 guidelines into additional languages may improve reporting completeness for the acute POCUS literature.Trial registration numberOpen Science Framework Registry (https://osf.io/5pzxs/).

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ObjectivesPoint-of-care ultrasound (POCUS) diagnostic accuracy research has significant variation in blinding practices. This study characterises the blinding practices during acute POCUS research to determine whether research methodology adequately reflects POCUS use in routine clinical practice.Design, settings and participantsA search for POCUS diagnostic accuracy studies published in Emergency Medicine, Anaesthesia and Critical Care journals from January 2016 to January 2020 was performed. Studies were included if they were primary diagnostic accuracy studies. The study year, journal impact factor, population, hospital area, body region, study design, blinding of the POCUS interpreter to clinical information, whether the person performing the POCUS scan was the same person interpreting the scan, and whether the study reported incremental diagnostic yield were extracted in duplicate by two authors. Descriptive statistics were provided and prespecified subgroup analysis was performed.Main outcome measuresThe primary outcome was the number of studies that blinded the POCUS interpreter to at least some part of the clinical information. Secondary outcomes included whether the person performing the POCUS scan was the same person interpreting it and whether the study reported incremental diagnostic yield.Results520 abstracts were screened with 97 studies included. The POCUS interpreter was blinded to clinical information in 37 studies (38.1%), not blinded in 34 studies (35.1%) and not reported in 26 studies (26.8%). The POCUS interpreter was the same person obtaining the images in 72 studies (74.2%), different in 14 studies (14.4%) and not reported in 11 studies (11.3%). Only four studies (4.1%) reported incremental diagnostic yield for POCUS. Inter-rater reliability was moderate (k=0.64). Subgroup analysis based on impact factor, body region, hospital area, patient population and study design did not show significant differences after completing pairwise comparisons.ConclusionsAlthough blinding the POCUS interpreter to clinical information may be done in a perceived attempt to limit bias, this may result in accuracy estimates that do not reflect routine clinical practice. Similarly, having a different clinician perform and interpret the POCUS scan significantly limits generalisability to practice as it does not truly reflect ‘point-of-care’ ultrasound at all. Reporting incremental diagnostic yield from implementing POCUS into a diagnostic pathway better reflects the value of POCUS; however, this methodology was infrequently used.Trial registration numberThe study protocol was registered on Open Science Framework (https://osf.io/h5fe7/).

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Background: The COVID-19 pandemic has resulted in over 1,000,000 cases across 181 countries worldwide. The global impact of COVID-19 has resulted in a surge of related research. Researchers have turned to social media platforms, namely Twitter, to disseminate their articles. The online database Altmetric is a tool which tracks the social media metrics of articles and is complementary to traditional, citation-based metrics. Citation-based metrics may fail to portray dissemination accurately, due to the lengthy publication process. Altmetrics are not subject to this time-lag, suggesting that they may be an effective marker of research dissemination during the COVID-19 pandemic. Objectives: To assess the dissemination of COVID-19 articles as measured by Twitter dissemination, compared to traditional citation-based metrics, and determine article characteristics associated with tweet rates. Methods: COVID-19 articles obtained from LitCovid published between January 1st to March 18th, 2020 were screened for inclusion. The following article characteristics were extracted independently, in single: Topic (General Info, Mechanism, Diagnosis, Transmission, Treatment, Prevention, Case Report, and Epidemic Forecasting), open access status (open access and subscription-based), continent of corresponding author (Asia, Australia, Africa, North America, South America, and Europe), tweets, and citations. A sign test was used to compare the tweet rate and citation rate per day. A negative binomial regression analysis was conducted to evaluate the association between tweet rate and article characteristics of interest. Results: 1328 articles were included in the analysis. Tweet rates were found to be significantly higher than citation rates for COVID-19 articles, with a median tweet rate of 1.09 (IQR 6.83) tweets per day and median citation rate of 0.00 (IQR 0.00) citations per day, resulting in a median of differences of 1.09 (95% CI 0.86-1.33, P < .001). 2018 journal impact factors were positively correlated with tweet rate (P < .001). The topics Diagnosis (P = .01), Transmission (P < .001), Treatment (P = .01), and Epidemic Forecasting (P < .001) were positively correlated with tweet rate, relative to Case Report. The following continents of the corresponding author were negatively correlated with tweet rate, Africa (P < .001), Australia (P = .03), and South America (P < .001), relative to Asia. Open access journals were negatively correlated with tweet rate, relative to subscription-based journals (P < .001). Conclusions: COVID-19 articles had significantly higher tweets rates compared to citation rates. This study further identified article characteristics that are correlated with the dissemination of articles on Twitter, such as 2018 journal impact factor, continent of the corresponding author, topic, and open access status. This highlights the importance of altmetrics in periods of rapidly expanding research, such as the COVID-19 pandemic to localize highly disseminated articles. Key words: COVID-19; Coronavirus; SARS-CoV-2; Altmetric; Twitter; Tweet; LitCovid; Citation; social media; research