Dr. Behcet Uz Children's Hospital

This study aimed to differentiate "pure" cognitive disengagement syndrome (CDS) from attention-deficit/hyperactivity disorder-restrictive inattentive presentation (ADHD-RI) by examining their neurocognitive profiles and associations with autistic traits (ATs) and depressive symptoms. A cross-sectional study was conducted involving three groups: pure CDS (n = 24), ADHD-RI (n = 32), and controls (n = 31). Participants underwent neuropsychological assessments using Computerized Neurocognitive Assessment Software (CNS) Vital Signs, alongside evaluations for ATs with the Autism Spectrum Screening Questionnaire, depressive symptoms with the Children's Depression Inventory, and CDS symptoms with the Barkley Child Attention Scale. A semi-structured interview was also conducted with all participants and their parents to ensure the diagnostic validity of the groups. Findings indicated no dimensional symptomatological distinctions between CDS and ADHD-RI, except for CDS symptoms, and demonstrated no significant differences in neurocognitive test profiles between CDS and ADHD-RI, except for the neurocognition index and reaction time. ATs and depressive symptoms did not significantly differ between the pure CDS and ADHD-RI groups but were significantly elevated in both groups compared to controls. The ADHD-RI group exhibited significantly worse performance than CDS concerning the neurocognition index and reaction time, and worse than controls regarding the neurocognition index, reaction time, psychomotor speed, and complex attention. This study elucidates that ADHD-RI and "pure" CDS have substantially overlapping neurocognitive and phenotypic profiles despite certain minor differences, which is detrimental to subjects with ADHD-RI in terms of overall neurocognition and reaction time. It can be argued that, compared to "pure" CDS, executive dysfunction might be slightly more specific to ADHD-RI, while depressive symptoms and ATs are common in both psychological constructs.

To present a decade-long single-center experience with neonatal meningomyelocele (MMC) and to emphasize the impact of surgical timing and concomitant anomalies in these neonates. Neonates with MMC between 2012 and 2022 were retrospectively analyzed. Perinatal data, concomitant deformities and anomalies, maternal data, MMC repair surgery duration, concurrent surgeries, complications, and central nervous system (CNS) infection were evaluated. Outcome of 134 neonates with MMC is reported. Hydrocephalus was seen in 88 (65.7%), Chiari type II malformation in 84 (62.7%), orthopedic anomaly in 41 (30.6%), rib anomaly in 17 (12.7%), kyphosis in 26 (19.4%), and scoliosis in 5 (11.2%) neonates. 59 (44.0%) neonates underwent MMC surgery in < 48 h. Wound dehiscence/cerebrospinal fluid (CSF) discharge at the MMC repair site occurred in 5 (8.5%) neonates; only 2 (3.4%) had CNS infection. Late (> 48 h) repair was performed on 75 (55.9%) neonates. 6(8%) neonates experienced wound dehiscence/CSF discharge, and 8 (10.7%) developed CNS infection. Kyphectomy was performed on 9/26 (34.6%) neonates. Prognostic factors for kyphectomy included pregnancy number of MMC neonate (p = 0.049), postpartum MMC repair day (p = 0.027), number of previous operations (p < 0.001), presence and number of concurrent surgeries (p < 0.001 and p < 0.001, respectively), and history of Chiari II operation (p = 0.002). The prognosis for neonates with MMC is primarily determined by the effective surgical and medical management of associated deformities and conditions, such as kyphosis, hydrocephalus, and Chiari type II malformation, rather than the timing of MMC sac repair (early vs. delayed surgery). The decision-making process regarding the timing and technique of corrective surgeries should focus on the severity of symptoms related to Chiari II malformation and kyphosis in the neonate rather than their radiologic presence.

The aim is to examine the relationship between Avoidant/Restrictive Food Intake Disorder (ARFID) symptoms and sensory sensitivities in children diagnosed with Autism Spectrum Disorder (ASD), as well as the relationship between maternal orthorexia nervosa (ON) and ARFID, and to identify the factors influencing ARFID. The symptom severity of 104 children was assessed using the Childhood Autism Rating Scale (CARS), maternal ON symptoms with ORTO-11, ARFID symptoms with the Nine-Item Avoidant/Restrictive Food Intake Disorder Screening Tool (NIAS), and sensory sensitivities with the Eyuboglu Sensory Reactivity Scale (ESRS). Multiple regression analyzed predictors of NIAS scores, and moderator analysis examined whether ORTO-11 moderated the ESRS-NIAS relationship. ON was present in 58% of the mothers. Mothers with ON had significantly higher total NIAS scores and NIAS Fear subscale scores. A positive and statistically significant relationship was found between the CARS scores and the hyporeactivity and sensory-seeking subscales of the ESRS scale. When NIAS was taken as the dependent variable, a significant regression relationship was found between CARS-9 and ORTO-11. However, ORTO-11 does not play a moderating role in the effect of ESRS on NIAS. ARFID symptoms are predicted by maternal ON symptoms and CARS-9 scores in children. We emphasize the importance of evaluating the eating attitudes and food perspectives of caregivers when atypical eating behaviors are identified in the clinical follow-up of children diagnosed with ASD. Since the study was conducted solely with mothers’, further research is needed to examine the effects of ON symptoms in fathers and other caregivers.

Background SMA Type 1 is the most severe form of spinal muscular atrophy with early symptom onset, limited motor development, and poor prognosis. Recent genetic-based therapies, such as nusinersen, have transformed disease outcomes. We aimed to evaluate the long-term effects of nusinersen on motor, bulbar, and respiratory functions in both symptomatic and presymptomatic SMA Type 1 patients over a period of up to 4 years. Methods This prospective, non-interventional study included 310 patients with genetically confirmed spinal muscular atrophy at 24 pediatric neurology centers in Turkey. Patients treated with nusinersen were divided into five age-based cohorts at treatment initiation: Cohort A (0–3 months), Cohort B (4–6 months), Cohort C (7–12 months), Cohort D (13–24 months), and Cohort E (>24 months). Efficacy was assessed using the CHOP-INTEND and WHO Motor Milestone Scale. This study also analyzed the respiratory support needs, gastrostomy requirements, and mortality rates across cohorts. Results Patients treated before 12 months of age showed the most significant improvements in motor milestones, with 58.7% of Cohort A achieving independent sitting. CHOP-INTEND scores increased notably in all cohorts, with the largest improvement observed in Cohort A (93.5%). Ventilator and gastrostomy requirements decreased in the early treated cohorts. Adverse events were rare, with one discontinuation due to hydrocephalus. The overall mortality rate was 21.3%, with most of the deaths occurring within the first year. Interpretation Nusinersen treatment initiated before 12 months of age, especially before 3 months of age, yielded the most favorable motor outcomes in patients with SMA type 1. Early initiation is associated with improved motor milestones and reduced need for ventilatory support. However, no significant improvements were observed in the bulbar function or in patients requiring extensive respiratory support.

Monitoring cardiovascular disease risk in children with cystic fibrosis using arterial stiffness: A new perspective Introduction: Early diagnosis with newborn screening programs and prolonged life expectancy with new treatment strategies have made cardiovascular disease (CVD) one of the important issues in cystic fibrosis (CF). In the early stages of CVD, it is difficult to recognize and follow-up increased arterial stiffness with conventional methods. Different measurement methods are needed. Therefore, in this study, we aimed to use arterial stiffness measurements in the follow-up of children with CF. Materials and Methods: This is a follow-up study examining the changes in arterial stiffness in children with CF by repeating hemodynamic measurements [augmentation index (AIx) and pulse wave velocity (PWV)]. We repeated hemodynamic measurements and CF-related CVD risk factors (Atherosclerosis risk factors: Fasting blood sugar, lipid profiles, and HbA1c) and systemic inflammation markers [C-reactive protein (CRP) and immunoglobulin G and pulmonary function tests] in children undergoing routine annual complication evaluation and examined changes during follow-up. Results: Hemodynamic measurements could be repeated in 37 of 52 patients due to inclusion criteria. Mean age of the study group was 12 ± 4.5 years and 48.6% were female. There was a statistically significant increase in high density lipoprotein, HbA1c, and CRP and a decrease in low density lipoprotein and FEV1 at the follow-up. Heart rate, central blood pressure, augmented pressure, and PWV were similar. AIx, peripheral systolic blood pressure (SBP), and mean arterial pressure were increased significantly (p < 0.05). The increase in AIx was greater than expected for age and greater in female patients and in those with low body mass index, moderate-severe disease, and high CRP levels. Also, the change in AIx was positively correlated with changes in peripheral SBP and CRP. Conclusion: This is the first study to evaluate the use of PWV and AIx in the follow-up of children with CF and showed that arterial stiffness measured with AIx increased at follow-up. The use of markers of arterial stiffness in CF from childhood onwards may enable early detection and monitoring of CVD risk and future prevention. Key words: Arterial stiffness; augmentation index; cystic fibrosis; pulse wave velocity analysis ÖZ Kistik fibrozisli çocuklarda kardiyovasküler hastalık riskinin arteriyel sertlik ile izlenmesi: Yeni bir bakış açısı Giriş: Yenidoğan tarama programları ile erken tanı konulması ve yeni tedavi stratejileri ile uzamış yaşam süresi kardiyovasküler hastalığı (KVH) kistik fibroziste (KF) dikkat çeken konulardan biri haline getirmiştir. Kardiyovasküler hastalıkların erken evrelerinde arteriyel sertlik artar ve bu evrede ekokardiyografi gibi konvansiyonel yöntemlerle değişiklikleri tanımak ve takip etmek zordur. Farklı ölçüm metotlarına ihtiyaç duyulmaktadır. Bu nedenle, bu çalışmada KF’li çocukların takibinde arteriyel sertlik ölçümlerini kullanmayı amaçladık. Materyal ve Metod: Kistik fibrozisli çocuklarda arteriyel sertliğin hemodinamik ölçümler [augmentasyon indeksi (Aİ) ve nabız dalga hızı (PWV)] tekrarlanarak değerlendirildiği bir takip çalışmasıdır. Yıllık rutin komplikasyon değerlendirmesi yapılan çocuklarda hemodinamik ölçümleri ve KF ilişkili KVH risk faktörlerini (Ateroskleroz risk faktörleri: Açlık kan şekeri, lipid profili, HbA1c), sistemik inflamasyon belirteçleri [C-reaktif protein (CRP) ve immünoglobulin G ve solunum fonksiyon testleri] tekrarladık ve takipteki değişimlerini inceledik. Bulgular: Hemodinamik ölçümler dahil edilme kriterleri nedeniyle 52 hastanın 37’sinde tekrarlanabilmiştir. Çalışma grubunun yaş ortalaması 12 ± 4.5 yıl olup %48.6’sı kadındı. Takipte yüksek yoğunluklu lipoprotein, HbA1c ve CRP’de istatistiksel olarak anlamlı bir artış, düşük yoğunluklu lipoprotein ve FEV1’de ise azalma görülmüştür. Kalp hızı, merkezi kan basıncı, artmış basınç ve PWV takipte benzerdi (p > 0.05). Augmentasyon indeksi, ortalama arter basıncı ve periferik sistolik kan basıncı (SKB) anlamlı olarak artmıştı (p < 0.05). Augmentasyon indeksindeki artış yaşa göre beklenenden daha büyüktü ve kadınlarda; düşük vücut kitle indeksi, orta-şiddetli hastalık ve yüksek CRP düzeyleri olan hastalarda daha fazlaydı. Ayrıca, Aİ’deki değişim periferik SKB ve CRP’deki değişimlerle pozitif korelasyon gösterdi. Sonuç: Bu çalışma, KF’li çocukların takibinde KVH risk belirteçleri PWV ve Aİ’nin kullanımını değerlendiren ilk çalışmadır ve KF’li çocuklarda Aİ ile ölçülen arteriyel sertliğin takipte arttığını göstermiştir. Çocukluk çağından itibaren KF’te arteriyel sertlik belirteçlerinin kullanımı, KVH riskinin erken saptanmasını, takibini ve gelecekte önlemler alınmasını sağlayabilir. Anahtar kelimeler: Arteriyel sertlik; augmentasyon indeksi; kistik fibrozis; nabız dalga hızı analizi

Purpose Differentiating between primary CNS lymphomas (PCNSL) and secondary CNS lymphomas (SCNSL) remains a challenge in imaging. The aim of this study was to differentiate histopathologically-proven PCNSL and SCNSL by using 25 qualitative VASARI and five other MRI features. Methods MRIs of 31 cases (19 PCNSL and 12 SCNSL) obtained between January 2010 and February 2022 were retrospectively reviewed. Two blinded readers independently evaluated images without knowledge of clinical data or whether CNS lymphoma was primary or secondary. The findings of each reader were recorded to assess interreader agreement. The results of two readers were evaluated by a senior neuroradiologist to reach a consensus. A statistical analysis was performed on the collected data. Results Most VASARI features showed no statistically significant differences between the two groups, except for two features. Tumor location exhibited a statistically different distribution between PCNSL and SCNSL groups (p = 0.036). Proportion of edema was greater in the PCNSL group compared to the SCNSL group (p = 0.049). Among other MRI features, infratentorial involvement was more frequent in the SCNSL group (p = 0.014), while notch sign was more commonly detected in the PCNSL group (p = 0.027). Inter-reader agreement for VASARI features ranged from moderate to almost perfect, and for other MRI features, it ranged from fair to almost perfect. Conclusion Despite the challenges in distinguishing imaging features of PCNSL and SCNSL; frontal lobe location, a higher proportion of edema and the presence of a notch sign may indicate PCNSL, while infratentorial involvement may suggest SCNSL.

Background Cyclophosphamide (CYC) is an inactive alkylating agent that transforms the alkyl radicals into other molecules and is used in combination with systemic corticosteroids in the treatment of many childhood rheumatic diseases, such as systemic lupus erythematosus (SLE), and ANCA-associated vasculitis (AAV). In recent years, rituximab (RTX), a B-cell-targeting anti-CD20 monoclonal antibody, has emerged as a new alternative treatment modality over CYC for induction therapy of childhood-onset rheumatic diseases. Clinicians adopt different practices for using CYC particularly in relation to indications, posology, pre-treatment laboratory work-up, post-treatment follow-up, and screening pre- and post-treatment vaccination status. This study aimed to evaluate the principles and approaches of administering CYC therapy in pediatric rheumatology and pediatric nephrology practices and to compare the clinician preferences for CYC and RTX in induction therapy of childhood-onset rheumatic diseases. Methods This study includes a web-based questionnaire executed on 87 participants (56 pediatric rheumatologists (PRs) and 31 pediatric nephrologists (PNs)). Both pediatric subspecialties evaluated and compared the most common indications for CYC treatment, pre-treatment consent protocols, pre-and post-treatment laboratory tests, dosing strategies, and side effects. Results Childhood-onset SLE (95%) and AAV (69%) were the most common diseases for which CYC treatment is used. All clinicians, except 2 PNs prescribed CYC via intravenous route. 61% of the PRs and 71% of PNs reported using a monthly dose of 500 mg/m² CYC for 6 months in accordance with the National Institutes of Health (NIH) protocol. All clinicians conducted pre-CYC treatment assessments of complete blood count and kidney function tests. Hepatitis B (82%), chickenpox (76%), and mumps-measles-rubella (72%) were the most frequently assessed vaccines. Adverse effects associated with CYC include cytopenia (86%), nausea (52%), liver toxicity (20%), hair loss (31%), hemorrhagic cystitis (37%), allergic reactions (16%), dyspnea (5%), and infertility (2%). 9 clinicians stated that they performed gonad-sparing interventions before CYC, which clarifies why CYC was more commonly preferred in the induction therapy of SLE and AAV over RTX by both PRs and PNs. Conclusions Clinicians still tend to choose CYC over RTX in induction therapy of SLE and AAV and mostly prefer the high-dose CYC treatment regimen suggested by the NIH.

The aim of the study is to elucidate demographic characteristics, risk factors, clinical presentations, causative agents, and management approaches pertaining to drug-related anaphylaxis in the paediatric population. This study is a multicenter retrospective study that included paediatric patients aged between 1 month and 18 years, who were admitted to the Pediatric Allergy and Immunology outpatient clinics of 11 participating centres with a presumptive diagnosis of drug-induced anaphylaxis, that fulfilled the standardised criteria for anaphylaxis, between January 2017 and December 2022. A total of 293 anaphylactic episodes presented among 265 patients, of which 48.1% (n 141) were female, were included. The median age of patients during the index episode was 107 months (IQR 56.5–161.5). Anaphylaxis occurred most frequently within hospital settings (62.1%, n 182) compared to home environments (34.1%, n 100). The administration were peroral in 40.3% (n 118), parenteral in 59.7% (n 175) of the cases. While antibiotics (56.7%), non-steroidal anti-inflammatory drugs (25.7%), and chemotherapeutics (3.4%) were the most commonly suspected drug groups, the cephalosporin group, and especially ceftriaxone (27.5% [n 80]) were the leading culprits among antibiotics. The anaphylaxis severity was severe in 39.6% (n 116), and moderate in 54.9% (n 161) of episodes. A biphasic reaction occurred in five patients. Only 72% (n 213) of patients were given adrenaline treatment. There were no fatalities. Diagnostic tests (n 64), including skin prick, intradermal, and drug provocation tests, which were performed between 1 and 120 months after the index reaction, yielded positive results in 23.4% (n 15), 17.2% (n 11), and 20.3% (n 13) of cases respectively, giving a total confirmation of 39 patients. Four patients underwent suspected drug desensitisation protocols. There were no fatalities. Conclusions: Antibiotics, particularly ceftriaxone, were the most commonly implicated agents in paediatric drug-induced anaphylaxis. Non-steroidal anti-inflammatory drugs, particularly ibuprofen, constituted the second most frequently implicated drug group. Paediatric patients experiencing drug-related anaphylaxis warrant algorithmic evaluation to ensure accurate diagnosis, prevent recurrence, and identify safe alternative treatments. What is Known: • Antibiotics, particularly ceftriaxone were the most frequently implicated culprit drugs, followed by NSAIDs, with ibuprofen being the most common within this group. What is New: • To the best of our knowledge, this is the largest multicenter paediatric drug-related anaphylaxis study, involving a large number of patients who evaluated by paediatric allergist. • We propose paediatric patients who experience drug induced anaphylaxis should undergo evaluation at specialized centres, to ensure accurate diagnosis, to prevent recurrence and identify safe alternative treatments.

Objective Caffeine is a proven medication used for the prevention and treatment of apnea in premature infants, offering both short- and long-term benefits. International guidelines provide a range of recommendations regarding the preterm population eligible for caffeine prophylaxis, including the timing, dosage, and duration of treatment. Our national guidelines, published prior to the most recent updates of the international guidelines, recommend the use of caffeine citrate starting from the first day after delivery for preterm infants with a gestational age of <28 weeks. For infants up to 32 weeks, if positive pressure ventilation is required, the decision should be made on an individual basis. This study aims to describe the variability in caffeine usage across neonatal intensive care units in our country. Methods An online survey was sent to neonatologist who are members of the Turkish Neonatology Society to describe the variability in caffeine usage in neonatal intensive care units in our country. Results We collected responses from 74 units. Prophylactic caffeine usage was observed as; GA ≤276/7: 98.6%, GA 280/7–286/7: 89.0%, GA 290/7–296/7: 75.3%, GA 300/7–316/7: 53.4%. 62.2% of units reported administering loading dose within the first two hours. The initial maintenance dose was 5 mg/kg in 64.8% of units, 10 mg/kg in 32.4% of units, and intermediate dose in 5.3% of units. 47.3% of units reported no routine dose adjustment. The postmenstrual age that caffeine treatment was stopped was found to be 34 (min-max; 32–36) weeks for infants without apnea and respiratory support, 36 (min-max; 34–52) weeks for infants without apnea but any respiratory support. The time to discharge after treatment cessation was found as; 1–4 days: 37.8%, 5–7 days: 68.9%. Among the 56 units with multiple responsible physicians, 32.1% reported intra-unit variations. Conclusion The significant differences in caffeine usage characteristics between and within units highlight the need for clear recommendations provided by standardized guidelines.

Background: Data on the impacts of vitamin D deficiency on sarcopenia in pediatric patients with inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are lacking. We aimed to investigate the relationships between vitamin D levels and sarcopenia in patients with newly diagnosed IBD. Methods: A cross-sectional, retrospective study was conducted in a tertiary care children’s hospital. Pediatric IBD patients who underwent magnetic resonance (MR) enteroclysis at the time of initial diagnosis were included. Total psoas muscle area (tPMA) at the L4/L5 intervertebral level was demonstrated on MR by scanning the right and left psoas muscle areas. Sarcopenia was defined as a measurement under the 10th percentile according to MR-derived reference values of tPMA percentile charts for healthy children aged 1–18 years. Vitamin D insufficiency was defined as a serum 25-OH-D level below 30 ng/mL and deficiency as that below 20 ng/mL. Collected data from demographic evaluation, clinic, and laboratory tests were statistically assessed. Results: According to the MR-derived reference values of tPMA, 85% (n = 33) of UC and 81% (n = 21) of CD patients had sarcopenia. The severe vitamin D deficiency ratio was 35.9% (n = 14) in UC and 38.5% (n = 10) in CD. We found that vitamin D levels were similar in patients with UC and CD, while they were significantly lower in the group below the 3rd percentile of tPMA (n = 41, median 9.8) than in the group between the 3rd and 10th percentiles (n = 13, median 16.9; p = 0.038). Conclusions: Formulating strategies to recognize and prevent sarcopenia, including the prevention and—if necessary—the treatment of vitamin D deficiency, could bring multi-faceted benefits.

Altmetrics is a web-based measurement method that assesses the online dissemination and interactions of an article. We performed an altmetric analysis of 500 papers with the highest altmetric attention score (AAS) published in anesthesiology-related journals. Journals were identified from the Web of Science (WoS) Master Journal List by Clarivate using the category “Anesthesiology.” The altmetric data were obtained from the Altmetric Explorer database. The first 500 publications with the highest AAS scores among these journals were identified and analyzed. Using Spearman correlation, no correlation was observed between the AAS and either WoS or Google Scholar citations ( R = 0.188, P < .001 and R = 0.161, P < .001, respectively). There was a weak correlation between blog mentions and both WoS citations and Google Scholar citations ( R = 0.263, P < .001 and ( R = 0.241, P < .001). A very strong correlation was observed between the number of Mendeley readers and both WoS and Google Scholar citations ( R = 0.889, P < .001 and R = 0.905, P < .001). A significant difference in AAS and WoS citations was observed based on publication topic ( P = .036 and P = .005, respectively), with algology being the most common topic (n = 206, 41.2%). Although AAS did not significantly affect traditional scientific citations, the analysis of subgroup correlations revealed notable differences. Our results suggest that traditional scientific citations (WoS and Google Scholar citations) are strongly influenced by the number of Mendeley readers. Further research is needed to understand these dynamics in academic discourse.

Background. Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) variants are essential for determining eligibility for CFTR modulator drugs (CFTRms). In contrast to Europe and the USA, the treatment eligibility profile of cystic fibrosis (CF) patients in Türkiye is not known. In this study we aimed to determine the eligibility of CF patients in Türkiye for the CFTRms. Methods. The Cystic Fibrosis Registry of Türkiye (CFrT) data was used to determine the age of patients in the year 2021 and the genetic variants they were carrying. Age- and CFTR-variant appropriate modulator therapies were determined using the Vertex® algorithm. Results. Among a total of 1930 registered patients, CTFR gene analysis was performed on a total of 1841 (95.4%) patients. Mutations were detected in one allele in 10.7% (198 patients), and in both alleles in 79% (1455 patients) of patients. A total of 855 patients (51.7% for whom at least 1 mutation was detected) were eligible for the drugs. The most appropriate drug among genotyped patients was found to be elexacaftor/tezacaftor/ivacaftor for 486 patients (26.4%), followed by ivacaftor for 327 patients (17.7%) and lumacaftor/ivacaftor for 42 patients (2%). Conclusions. Only half of patients registered in CFrT were eligible for CFTRms, which is a significant difference from the CFTR variant profile seen in USA and Europe. However, access to treatment is hampered for some patients whose genes are not analysed. Further studies in CF populations, where rare mutations are relatively more common, will contribute to the field of CFTR modulator treatments for such rare mutations.

Introduction Alternative metrics (altmetrics) have emerged as invaluable tools for assessing the influence of scholarly articles. In this study we aimed to evaluate correlations between Altmetric Attention Scores (AAS), and sources and actual citations in articles displaying the highest AAS within emergency medicine (EM) journals. Methods We conducted an analysis of EM journals listed in the Science Citation Index Expanded (SCIE) using the Altmetric Explorer tool. We analyzed the journals that received the highest number of mentions, the sources of AAS, the regions most frequently mentioned, and the geographical distribution of mentions. In the subsequent stage of our analysis, we conducted an examination of the 200 top-ranked articles that had received high AAS and were published in SCIE EM journals from January 1, 2013–January 1, 2023. We sought to determine the correlations between the AAS and the citation counts of articles on Google Scholar and the Web of Science (WOS). Results Of 40,840 research outputs evaluated, there were 510,047 shares across multiple platforms. The AAS were present for 36,719 articles (89.9%), while 10.1% had no score. In the review of the top 200 articles with the highest AAS, the median score was 382.5 (interquartile range 301.3–510.8). Of the research output evaluated, 38% were observational studies, 13% case reports, and 13% reviews/meta-analyses. The most common research topics were emergency department (ED) management and COVID-19. There was no correlation between AAS and WOS citation numbers (rs = −0.041, P = 0.563, 95% confidence interval [CI] −0.175–0.087). There was a weak correlation identified between WOS citations and mentions on X, and a moderate correlation observed for WOS citations and blog mentions (rs = 0.330, P < .001, 95% CI 0.174 to 0.458; rs ² = 0.109, and rs = 0.452, P < .001, 95% CI 0.320–0.566; and rs ² = 0.204, respectively). However, we found a strong positive correlation between WOS citations and the number of Mendeley readers (rs = 0.873, P < .001, 95% CI 0.82–0.911, rs ² = 0.762). Conclusion While most articles in EM journals received an AAS, we found no correlation with traditional citation metrics. However, Mendeley readership numbers showed a strong positive correlation with citation counts, suggesting that academic platform engagement may better predict scholarly impact.