LAUSR

BACKGROUND Normal pressure hydrocephalus (NPH) is a syndrome that was characterized several decades ago; however, its optimal diagnosis and management remain unclear. Our objective was to evaluate citation and bibliometric characteristics of the 100 most cited articles about NPH in order to better understand the state of current research efforts in the field and where improvements may arise. METHODS Elsevier's Scopus database was searched for the 100 most cited articles that focused on NPH. Articles were characterized and various bibliometric parameters were compared. Categorical data were analyzed using Pearson's Chi-square, and continuous data were analyzed using either linear regression or Student's t-test. RESULTS The 100 most cited articles were published between 1965-2014, from 16 unique countries in 38 unique journals. The most common outcome types of these articles were clinical (n=77) in nature. Median number of citations and rate of citations were 114 citations and 5.9 citations/year since publication, respectively, with a significant inverse linear relationship between the two parameters (P<0.01). The most common year of publication was 2002 (n=10), and country of origin was the United States (n=40). Higher citation rates were associated with more recent articles (P<0.01) and more authors (P<0.01). CONCLUSIONS In the 100 most cited articles about NPH, there is a distinct shift towards a more globalized effort in recent decades. The lack of more impactful articles in recent decades, highlights particular classic studies still penetrate practice today, and the possible need to reconsider our contemporary views on NPH to further advance the field.