Writing for Pediatric Critical Care Medicine: What to Expect In the Final Pre-Acceptance Requests From the Editor

At Pediatric Critical Care Medicine (PCCM), we use specialists to review articles submitted to the journal. These clinical and academic content experts address two key questions for the editors: 1) Is the topic and content timely and a priority? and 2) Is the clinical and academic reasoning and argument good? The main part of this evaluation is to assess whether the methodology and data (i.e., Tables and Figures) should be presented to readers with the imprimatur of PCCM. We take the view that everything else about the manuscript can achieve our expected standards by resubmission, such as length, structure, use of language, and the Introduction and Discussion (1–5). That is, if the methods and data are robust, important, and a priority, we will try our best to make the work available to readers. After the early stages of an article’s path to acceptance (with serial iterations in review, resubmission, and re-review), there follows my editor-in-chief reading before the publisher’s “technical” review. At the time of my pre-publisher’s review, approval for acceptance has not occurred but will come when the final corrections and edits are completed. The publisher’s technical review then translates (using post-acceptance “processes”) the manuscript files into the journal’s house style and production format (6). Therefore, the purpose of this new item in the “Writing for PCCM” series is to help authors with the requirements underlying the pre-acceptance requests from the editor. GENERAL COMMENTS Most clinical research articles submitted to PCCM arise from either single-center retrospective studies or analyses of multicenter datasets or administrative databases (1,2,4). Because PCCM is unique in providing a large volume of such research literature for PICU clinicians around the world (7), we have evolved our own requirements for article publication. These criteria are used to ensure that all content is written in a way that is not only open and transparent, but it is a report that readers of PCCM can trust (8). Therefore, two general aspects of my editor’s reading and review are focused on language and statistical presentation. The approach taken regarding language is as described in the Writing for PCCM series that can be found on the journal website, or by accessing the individual articles (1–5). For retrospective or database studies we essentially expect authors to use what we colloquially call the “language of association” throughout the text. For example, in retrospective studies we are not able to say, “no association,” but we can say “failure to identify an association.” Because we do not have access to language editors at PCCM–who would otherwise help authors using American English as a second language–other language edits will come from the editor at that stage. The purpose of the editing is to improve overall readability, coherence and clarity of argument, and comprehensibility of the manuscript without altering the authors’ voice or scientific meaning (9). That stage may involve some restructuring or rewriting of sections for better flow in logic for the PCCM readership. At other journals, this stage may occur after acceptance of an article using in-house professional technical editors, or before acceptance as part of a fee-for-service arrangement with scientific author services. The approach taken at PCCM regarding use of statistics when referring to observations and data from retrospective studies follows those outlined in standard texts, and a personal favorite is Warren S. Browner’s book Publishing and Presenting Clinical Research (10). Please note that in PCCM we typically do not use p values in the table of demographics for comparing each patient group (1,4). We do not permit presentation of percentages for proportions when the denominator is < 50. However, it is sometimes helpful to give readers such information in the discussion of an article, but then the percentage will need to be presented with a 95% confidence interval (95% CI). Similarly, when a difference in two proportions (each with small denominators) is presented in a univariate analysis for the primary or secondary outcome, the difference should be given as a percentage, along with the 95% CI of the difference. SPECIFIC COMMENTS The specific comments from the editor come after close reading of the entire manuscript and all the files. The motivation here is to make sure that future readers of the article will gain the best from the content. Table 1 summarizes some of the details that are recurring themes in editorial feedback to authors. This checklist should be added to the features and outlines described in other Writing for PCCM articles (1–5). Table 1. - Checklist for Editor’s Review Section or Part of Manuscript Requirements Title Topic or field of study, followed by a colon, and then the methodology and years of study. Abstract When was the study done, how many patients, and is there is a ClinicalTrials.gov (NCT) number that should be included? Information Boxes Include a “Research in context” and a “What this study means,” or “At the bedside” box; each has three bullet points, which are brief. Introduction Two paragraphs to save text for the Discussion. There is no need to provide a topic review, just the why and what was done, and the idea. Methods The research ethics committee approval comes first, with exact date. This date is checked against the dates of references in the Introduction. Results All Figures and Tables are checked along with the accompanying text. Make sure that precision and accuracy is appropriate, and the same. Supplemental Digital Content This content must be “camera ready” because it is not copyedited but posted online as submitted. Discussion Make sure that the observations are presented in the context of the most up-to-date literature, meaning the last couple of years. References All references are fact-checked for accuracy and relevance of content being quoted. Redundant references need to be removed. Common issues arising in the Title and Abstract are incorrect use of certain words. For example, in the title, retrospective studies cannot be used to examine the “impact” of some change in practice, or “safety” of a particular approach. Such studies are designed to report numbers of retrospectively defined or captured events, and inferences about causation, impact, or safety are items for the Discussion section. The format for PCCM titles should make it clear to readers what they will be looking at (Table 1). Declaring a result or asking a question in the title leads to the obvious response: do I really need to read this since I now know the result; or, if the authors are still asking a question and therefore don’t know the answer, then why bother to read this! The abstract must tell readers when the study was done and how many patients were in the dataset, rather than obscuring actual numbers or proportions with percentages. The Introduction should contain a description of why the study was done and what was done. The “Why” is supported by an argument and careful use of references. If the new report follows from your recent publication using the same dataset, then declare that immediately because it makes the introduction more efficient. Also, because PCCM’s readership comprises PICU clinicians, certain aspects of our practice are obvious, so a topic review is not needed. Similarly, use references to what was relevant when the study was planned, which means when quoting a study that supports your assertion or reasoning, the cohort should be within 3 years of your own research plan. Otherwise, it is not about now, but about then, which may not be relevant at all. If there was no relevant information around the time of your study cohort, then an accurate portrayal of the age of the information and the gap in knowledge is needed. This approach may also add to the necessity and importance of the work you carried out. In the Methods and Results sections, the ethical statement comes first. When was the approval gained and when was the study done? If there is mismatch in this information, some clarifications will be needed. That is, approval coming after an apparent period of “prospective” data collection, likely means the work was a retrospective study (11). Enough description of methods should be presented to make results understandable, which includes giving the definition to terms being used and describing any special tests. The units and precision of data in the text, tables and figures, abstract, and supplemental digital content all need to be appropriate, and the same (12). No rounding up or down of numbers between a table and the text (or vice versa)–all cross-referencing must be consistent. Rounding can be used in the discussion. Finally, Figures and Tables are checked, including all numbers, proportions, and totals. The Discussion and References are fact-checked to verify all information presented, check for any inconsistencies, and ensure that the emphases and conclusions align with the study’s results and citations used. References need to be up to date and cover the most recent narratives on the topic (11). Names of authors and year of publication are not the most important aspect of a citation when being quoted in the text. What is relevant is the years of that particular study cohort, the number of patients, and the number of outcomes. Help readers to understand the literature and the place of your observations in that context rather than just the author’s name and year of publication. Last, if there is a significant gap between the timing of your cohort and the year of upcoming publication after acceptance, be careful about your conclusions and what is recommended to readers. Importantly, consider whether any recommendations are how you now practice. ENDNOTE Authors and readers should be aware that journal publication has entered a new era. There are concerted efforts to identify unreliable and fraudulent forms of academic publication in pediatrics, critical care, and the broader fields of science (13–15), and these are an everyday part of monitoring by research organizations (e.g., https://retractionwatch.com). In fact, detection of plagiarism and work products of “paper mills” (16–18) using interrogative software is also becoming a regular part of how journals assess manuscripts before publication. These tools will be used at PCCM as a way of showing readers our due diligence in research evaluation, thereby protecting our readers and the PCCM brand. Please do not be put off from submitting to PCCM by the requirements of the new era. As ever, we welcome all new clinical research in pediatric critical care topics at PCCM. The pre-acceptance editorial review is a necessary part of our contemporary process, and the idea is to ensure that your accepted article is the best it can be for our readers, and for you as authors.