The anatomy of an article: the discussion section: "how does the article I read today change what I will recommend to my patients tomorrow?"
Venue: The journal of trauma and acute care surgery
Year: 2013

E 30 years ago, Sauaia and Sauaia (the first author and her father) published a series of articles on 'editing a scientific article. The ideawas to assist the reader to incorporate the knowledge brought by an article into what he or she already knows about a certain topic and ultimately translate this into improving their patients' care. Since then, substantial effort has been made to standardize the reporting of scientific articles. These are well documented by the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network, an international initiative that grew out of the CONSORT (CONsolidated Standards of Reporting Trials) Statement and other reporting guideline development groups and brings together leading experts in health research methodology, statistics, reporting, and editorial work. An increasing number of journals (including the Journal of Trauma and Acute Care Surgery) are requiring or encouraging authors to follow these guidelines, yet a large proportion of studies do not adhere to this valuable practice. Some authors feel that such guidelines curtail creativity and style. However, it is important to remember that writing style and reports of scientific investigation are not the same thing. The latter requires norms and rules that allow the reader to translate the study's findings to clinical practice, eventually benefitting patients and society. We call your attention to the word translate. Translational science is a popular term today; all medical scientific findings, from basic science to clinical trials, should translate, sooner or later, into better patient care. Thus, we must ensure tha the 'translation' is as clear, accurate, and immune to misunderstanding as possible. The readers, our primary customers, wish to learn and improve the care they provide or develop their own research agenda; thus we, the authors, must assist them in achieving these goals in an efficient manner. This article, the first of a series on the 'anatomy of an article, concentrates on the Discussion, about which little has been written in terms of standardization. We believe that the Discussion is crucial to optimally assist the reader to translate the results of the article to his or her clinical practice or research. Reporting standards for the Discussion section currently exist (Table 1) but they give little direction to what should be included. Indeed, these recommendations for the Discussion section are much less explicit than the recommendations for the Methods and Results sections, which specifically guide the authors on which elements to include. Common to all is the recommendation to be cautious in the interpretation or extrapolation of the results. Most also suggest that the Discussion include statements about the generalizability and the limitations of the study. Hess, in an excellent article from 2004, provides more direct guidance on what to include and what to avoid in the Discussion. In brief, he proposes that the Discussion starts with a statement of the study's major findings, followed by explanations of (1) the meaning and importance of the results, (2) how the study findings relate to other studies, (3) alternative explanations for the observations, (4) clinical relevance of the findings, (5) acknowledgement the study's limitations, and (6) ending with suggestions for further research. He also advises authors to place a take home message in a separate section, named Conclusions. Hess's recommendations do not address the two most common mistakes in the Discussion: repetition of the material in the Results section and redundant elaboration of a longer Introduction section. Neither of these achieves the goal of assisting the reader in translating the findings into clinical practice or into furthering their research agenda. We would like to go one step further and provide a standard structure for this important section tied to our recently published evidence level of individual articles. Our proposed structure for the Discussion section combines Hess's recommendations with our recently proposed evidence level of individual studies (ELIS) which now accompanies every clinical study published in the Journal, and the PICO format for framing the question, 'Are patients [P] interventions [I] comparators [C] and outcomes [O] in the trial similar enough to justify application of the trial results to the provider's patient population? The proposed structured Discussion includes the following: 1. One sentence to reiterate the purpose of the study, picking up fromwhere Introduction left off. We suggest that authors use the same language as in thefinal sentence of the Introduction.