Jennifer Chen, MD

All Publications

• Photopatch Testing Among Members of the American Contact Dermatitis Society. Dermatitis : contact, atopic, occupational, drug Kim, T., Taylor, J. S., Maibach, H. I., Chen, J. K., Honari, G. 2020

  Abstract

  BACKGROUND: Photopatch testing is an important diagnostic tool in evaluating patients with suspected photoallergic contact dermatitis. Although protocols for photopatch testing have been described, there are no consensus recommendations by the American Contact Dermatitis Society (ACDS).OBJECTIVES: The aims of this study were to examine the common practices of photopatch testing among ACDS members and to review and compare commonly used photoallergen series.METHODS: We conducted a questionnaire-based survey among ACDS members via e-mail to inquire about their photopatch test methods. We compared the results with the European consensus methodology and reviewed photoallergen series reported by the respondents.RESULTS: Of the 791 members contacted, 112 members (14%) responded to the survey. Among these, 50 respondents (45%) perform photopatch testing, approximately half of whom (48%) determine minimal erythema dose before the test using UVA with or without UVB irradiation. Respondents use a total of 13 photoallergen series, alone or in any combination, as well as customized series.CONCLUSIONS: These results have potential to aid clinicians in identifying photoallergen series best suited for their patients and suggest a need for consensus recommendations by the ACDS.

  View details for DOI 10.1097/DER.0000000000000535

  View details for PubMedID 31905187

• Dupilumab Treatment of Nummular Dermatitis: A Retrospective Cohort Study. Journal of the American Academy of Dermatology Choi, S., Zhu, G. A., Lewis, M. A., Honari, G., Chiou, A. S., Ko, J., Chen, J. K. 2020

  View details for DOI 10.1016/j.jaad.2019.12.054

  View details for PubMedID 31923445

• Inflammatory alopecia in patients on dupilumab: a retrospective cohort study at an academic institution. Journal of the European Academy of Dermatology and Venereology : JEADV Zhu, G. A., Kang, K. J., Chen, J. K., Novoa, R. A., Brown, R. A., Chiou, A. S., Ko, J. M., Honari, G. 2019

  Abstract

  Dupilumab targets IL-4Ralpha and is used for moderate-to-severe atopic dermatitis (AD). Prior reports have described new alopecia areata (AA),1 flaring of prior AA,2 as well as improvement or resolution of AA3 in patients treated with dupilumab. We conducted a retrospective cohort study to describe the natural history of prior or new inflammatory alopecia in patients on dupilumab.

  View details for DOI 10.1111/jdv.16094

  View details for PubMedID 31737955

• Assessment of the Development of New Regional Dermatoses in Patients Treated for Atopic Dermatitis With Dupilumab JAMA DERMATOLOGY Zhu, G., Chen, J. K., Chiou, A., Ko, J., Honari, G. 2019; 155 (7): 850?52

  View details for DOI 10.1001/jamadermatol.2019.0109

  View details for Web of Science ID 000482127300017

• Development andValidation of a Risk Prediction Model for In-Hospital MortalityAmong Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-ABCD-10 JAMA DERMATOLOGY Noe, M. H., Rosenbach, M., Hubbard, R. A., Mostaghimi, A., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Hughey, L. C., Kaffenberger, B. H., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Musiek, A., Ortega-Loayza, A. G., Sharon, V. R., Shinkai, K., Summers, E. M., Wanat, K. A., Wetter, D. A., Worswick, S., Margolis, D. J., Gelfand, J. M., Micheletti, R. G. 2019; 155 (4): 448?54

  View details for DOI 10.1001/jamadermatol.2018.5605

  View details for Web of Science ID 000464040200008

• Repeat patch testing in a patient with allergic contact dermatitis improved on dupilumab. JAAD case reports Zhu, G. A., Chen, J. K., Chiou, A., Ko, J., Honari, G. 2019; 5 (4): 336?38

  View details for PubMedID 30989102

• Development and Validation of a Risk Prediction Model for In-Hospital Mortality Among Patients With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis-ABCD-10. JAMA dermatology Noe, M. H., Rosenbach, M., Hubbard, R. A., Mostaghimi, A., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. D., Dominguez, A., Fox, L. P., Hughey, L. C., Kaffenberger, B. H., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Musiek, A., Ortega-Loayza, A. G., Sharon, V. R., Shinkai, K., Summers, E. M., Wanat, K. A., Wetter, D. A., Worswick, S., Margolis, D. J., Gelfand, J. M., Micheletti, R. G. 2019

  Abstract

  Importance: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a spectrum of severe mucocutaneous drug reaction associated with significant morbidity and mortality. A previously developed SJS/TEN-specific severity-of-illness model (Score of Toxic Epidermal Necrolysis [SCORTEN]) has been reported to overestimate and underestimate SJS/TEN-related in-hospital mortality in various populations.Objective: To derive a risk prediction model for in-hospital mortality among patients with SJS/TEN and to compare prognostic accuracy with the SCORTEN model in a multi-institutional cohort of patients in the United States.Design, Setting, and Participants: Data from a multicenter cohort of patients 18 years and older treated for SJS/TEN between January 1, 2000, and June 1, 2015, were obtained from inpatient consult databases and electronic medical record systems at 18 medical centers in the United States as part of the Society for Dermatology Hospitalists. A risk model was derived based on data from 370 of these patients. Model discrimination (calculated as area under the receiver operating characteristic curve [AUC]) and calibration (calculated as predicted vs observed mortality, and examined using the Hosmer-Lemeshow goodness-of-fit statistic) were assessed, and the predictive accuracy was compared with that of SCORTEN. All analysis took place between December 2016 and April 2018.Main Outcomes and Measures: In-hospital mortality.Results: Among 370 patients (mean [SD] age 49.0 [19.1] years; 195 [52.7%] women), 54 (15.14%) did not survive to hospital discharge. Five covariates, measured at the time of admission, were independent predictors of in-hospital mortality: age in years (odds ratio [OR], 1.05; 95% CI, 1.02-1.07), body surface area (BSA) in percentage of epidermal detachment (OR, 1.02; 95% CI, 1.01-1.04), serum bicarbonate level below 20 mmol/L (OR, 2.90; 95% CI, 1.43-5.88), active cancer (OR, 4.40; 95% CI, 1.82-10.61), and dialysis prior to admission (OR, 15.94; 95% CI, 3.38-66.30). A severity-of-illness score was calculated by taking the sum of 1 point each for age 50 years or older, epidermal detachment greater than 10% of BSA, and serum bicarbonate level below 20 mmol/L; 2 points for the presence of active cancer; and 3 points for dialysis prior to admission. The score was named ABCD-10 (age, bicarbonate, cancer, dialysis, 10% BSA). The ABCD-10 model showed good discrimination (AUC, 0.816; 95% CI, 0.759-0.872) and calibration (Hosmer-Lemeshow goodness of fit test, P=.03). For SCORTEN, on admission, the AUC was 0.827 (95% CI, 0.774-0.879) and was not significantly different from that of the ABCD-10 model (P=.72).Conclusions and Relevance: In this cohort of patients with SJS/TEN, ABCD-10 accurately predicted in-hospital mortality, with discrimination that was not significantly different from SCORTEN. Additional research is needed to validate ABCD-10 in other populations. Future use of a new mortality prediction model may provide improved prognostic information for contemporary patients, including those enrolled in observational studies and therapeutic trials.

  View details for PubMedID 30840032

• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States (vol 138, pg 2315, 2018) JOURNAL OF INVESTIGATIVE DERMATOLOGY Micheletti, R. G., Chiesa-Fuxench, Z., Noe, M. H., Stephen, S., Aleshin, M., Agarwal, A., Boggs, J., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Gordon, S., Hamrick, R., Ho, B., Hughey, L. C., Jones, L. M., Kaffenberger, B. H., Kindley, K., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Mostaghimi, A., Musiek, A., Ortega-Loayza, A. G., Patel, R., Posligua, A., Rani, M., Saluja, S., Sharon, V. R., Shinkai, K., St John, J., Strickland, N., Summers, E. M., Sun, N., Wanat, K. A., Wetter, D. A., Worswick, S., Yang, C., Margolis, D. J., Gelfand, J. M., Rosenbach, M. 2019; 139 (2): 495?96

  View details for DOI 10.1016/j.jid.2018.11.013

  View details for Web of Science ID 000456162000049

• Assessment of the Development of New Regional Dermatoses in Patients Treated for Atopic Dermatitis With Dupilumab. JAMA dermatology Zhu, G. A., Chen, J. K., Chiou, A., Ko, J., Honari, G. 2019

  View details for PubMedID 31042259

• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Multicenter Retrospective Study of 377 Adult Patients from the United States JOURNAL OF INVESTIGATIVE DERMATOLOGY Micheletti, R. G., Chiesa-Fuxench, Z., Noe, M. H., Stephen, S., Aleshin, M., Agarwal, A., Boggs, J., Cardones, A. R., Chen, J. K., Cotliar, J., Davis, M. P., Dominguez, A., Fox, L. P., Gordon, S., Hamrick, R., Ho, B., Hughey, L. C., Jones, L. M., Kaffenberger, B. H., Kindley, K., Kroshinsky, D., Kwong, B. Y., Miller, D. D., Mostaghimi, A., Musiek, A., Ortega-Loayza, A. G., Patel, R., Posligua, A., Rani, M., Saluja, S., Sharon, V. R., Shinkai, K., St John, J., Strickland, N., Sun, N., Wanat, K. A., Wetter, D. A., Worswick, S., Yang, C., Margolis, D. J., Gelfand, J. M., Rosenbach, M. 2018; 138 (11): 2315?21

  Abstract

  Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare, severe mucocutaneous reaction with few large cohorts reported. This multicenter retrospective study included patients with SJS/TEN seen by inpatient consultative dermatologists at 18 academic medical centers in the United States. A total of 377 adult patients with SJS/TEN between January 1, 2000 and June 1, 2015 were entered, including 260 of 377 (69%) from 2010 onward. The most frequent cause of SJS/TEN was medication reaction in 338 of 377 (89.7%), most often to trimethoprim/sulfamethoxazole (89/338; 26.3%). Most patients were managed in an intensive care (100/368; 27.2%) or burn unit (151/368; 41.0%). Most received pharmacologic therapy (266/376; 70.7%) versus supportive care alone (110/376; 29.3%)-typically corticosteroids (113/266; 42.5%), intravenous immunoglobulin (94/266; 35.3%), or both therapies (54/266; 20.3%). Based on day 1 SCORTEN predicted mortality, approximately 78 in-hospital deaths were expected (77.7/368; 21%), but the observed mortality of 54 patients (54/368; 14.7%) was significantly lower (standardized mortality ratio = 0.70; 95% confidence interval = 0.58-0.79). Stratified by therapy received, the standardized mortality ratio was lowest among those receiving both steroids and intravenous immunoglobulin (standardized mortality ratio = 0.52; 95% confidence interval 0.21-0.79). This large cohort provides contemporary information regarding US patients with SJS/TEN. Mortality, although substantial, was significantly lower than predicted. Although the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and intravenous immunoglobulin, among other therapies, may warrant further study.

  View details for PubMedID 29758282

• Pediatric Baseline Patch Test Series: Pediatric Contact Dermatitis Workgroup DERMATITIS Yu, J., Atwater, A., Brod, B., Chen, J. K., Chisolm, S. S., Cohen, D. E., de la Feld, S., Gaspari, A. A., Martin, K., Montanez-Wiscovich, M., Sheehan, M., Silverberg, N., Lugo-Somolinos, A., Thakur, B. K., Watsky, K., Jacob, S. E. 2018; 29 (4): 206?12

  Abstract

  Allergic contact dermatitis is a challenging diagnostic problem in children. Although epicutaneous patch testing is the diagnostic standard for confirmation of contact sensitization, it is less used in children by dermatologists treating children, pediatric dermatologists, and pediatricians, when compared with adult practitioners.The aim of the study was to create and evaluate standardization of a pediatric patch test series for children older than 6 years.We surveyed dermatologists and allergists conducting epicutaneous patch testing in children attending the 2017 American Contact Dermatitis Society meeting held in Washington, DC. This was followed by discussion of collected data and consensus review by a pediatric contact dermatitis working group at the conference.A baseline pediatric patch test panel was established through working group consensus.

  View details for PubMedID 29933256

• Metal Allergy: From Dermatitis to Implant and Device Failure edited by Chen, J. K., Thyssen, J. P. 2018
• A Retrospective Study of 305 Cases of Angioimmunoblastic T-Cell Lymphoma with Emphasis on Rare Lymphoplasmacytic and Plasma Cell Proliferations Oak, J., Hoffmann, J. C., Chisholm, K. M., Chen, J., Zehnder, J., Arber, D. A., Natkunam, Y., Warnke, R., Ohgami, R. NATURE PUBLISHING GROUP. 2017: 367A?368A

  View details for Web of Science ID 000393724401748

• A Retrospective Study of 305 Cases of Angioimmunoblastic T-Cell Lymphoma with Emphasis on Rare Lymphoplasmacytic and Plasma Cell Proliferations Oak, J., Hoffinann, J. C., Chisholm, K. M., Chen, J., Zehnder, J., Arber, D. A., Natkunam, Y., Warnke, R., Ohgami, R. NATURE PUBLISHING GROUP. 2017: 367A?368A

  View details for Web of Science ID 000394467302051

• A Pragmatic Approach to Patch Testing Atopic Dermatitis Patients: Clinical Recommendations Based on Expert Consensus Opinion DERMATITIS Chen, J. K., Jacob, S. E., Nedorost, S. T., Hanifin, J. M., Simpson, E. L., Boguniewicz, M., Watsky, K. L., Lugo-Somolinos, A., Hamann, C. R., Eberting, C. L., Silverberg, J. I., Thyssen, J. P. 2016; 27 (4): 186-192

  Abstract

  Allergic contact dermatitis (ACD) may complicate the clinical course of atopic dermatitis (AD), and patch testing remains the criterion standard for diagnosing ACD. To date, there have been no guidelines or consensus recommendations on when and how to patch test individuals with AD. Failure to patch test when appropriate may result in overlooking an important and potentially curable complicating comorbidity. In this article, we present consensus recommendations regarding when to perform patch testing in the AD patient, best practices, and common pitfalls. Patch testing should be considered in AD patients with dermatitis that fails to improve with topical therapy; with atypical/changing distribution of dermatitis, or pattern suggestive of ACD; with therapy-resistant hand eczema in the working population; with adult- or adolescent-onset AD; and/or before initiating systemic immunosuppressants for the treatment of dermatitis. A suggested patch testing algorithm for AD patients is provided.

  View details for DOI 10.1097/DER.0000000000000208

  View details for PubMedID 27427820

• Characterization of patients with clinical overlap of morphea and systemic sclerosis: A case series JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Chen, J. K., Chung, L., Fiorentino, D. F. 2016; 74 (6): 1272?74

  View details for PubMedID 27185438

• Corticosteroids in Myositis and Scleroderma. Rheumatic diseases clinics of North America Postolova, A., Chen, J. K., Chung, L. 2016; 42 (1): 103-118

  Abstract

  Idiopathic inflammatory myopathies (IIMs) involve inflammation of the muscles and are classified by the patterns of presentation and immunohistopathologic features on skin and muscle biopsy into 4 categories: dermatomyositis, polymyositis, inclusion body myositis, and immune-mediated necrotizing myopathy. Systemic corticosteroid (CS) treatment is the standard of care for IIM with muscle and organ involvement. The extracutaneous features of systemic sclerosis are frequently treated with CS; however, high doses have been associated with scleroderma renal crisis in high-risk patients. Although CS can be effective first-line agents, their significant side effect profile encourages concomitant treatment with other immunosuppressive medications to enable timely tapering.

  View details for DOI 10.1016/j.rdc.2015.08.011

  View details for PubMedID 26611554

• Erythematous Plaques on the Buttock JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Tan, C. Z., Novoa, R., Chen, J. K. 2016; 315 (1): 79-80

  View details for DOI 10.1001/jama.2015.13562

  View details for PubMedID 26746461

• Gold Contact Allergy: Clues and Controversies DERMATITIS Chen, J. K., Lampel, H. P. 2015; 26 (2): 69-77

  Abstract

  In 2001, gold was named Contact Allergen of the Year. More than a decade later, we continue to face several challenges in defining the role of gold in contact allergy. First, interpretation of gold reactions in the setting of epicutaneous patch testing may be difficult; in addition to being a common irritant, gold may be associated with significantly delayed and persistent reactions. Second, although gold compounds are commonly positive on patch testing, clinical relevance is relatively low and may be challenging to determine. Third, the complex interplay between gold and the human body is still poorly understood. In this review, we provide an overview of the literature concerning gold patch test positivity and present recommendations for epicutaneous patch testing with gold.

  View details for DOI 10.1097/DER.0000000000000101

  View details for Web of Science ID 000350912200003

  View details for PubMedID 25757078

• Prehospital Use of Magnesium Sulfate as Neuroprotection in Acute Stroke NEW ENGLAND JOURNAL OF MEDICINE Saver, J. L., Starkman, S., Eckstein, M., Stratton, S. J., Pratt, F. D., Hamilton, S., Conwit, R., Liebeskind, D. S., Sung, G., Kramer, I., Moreau, G., Goldweber, R., Sanossian, N., FAST-MAG Investigators Coordinator 2015; 372 (6): 528?36

  Abstract

  Magnesium sulfate is neuroprotective in preclinical models of stroke and has shown signals of potential efficacy with an acceptable safety profile when delivered early after stroke onset in humans. Delayed initiation of neuroprotective agents has hindered earlier phase 3 trials of neuroprotective agents.We randomly assigned patients with suspected stroke to receive either intravenous magnesium sulfate or placebo, beginning within 2 hours after symptom onset. A loading dose was initiated by paramedics before the patient arrived at the hospital, and a 24-hour maintenance infusion was started on the patient's arrival at the hospital. The primary outcome was the degree of disability at 90 days, as measured by scores on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability).Among the 1700 enrolled patients (857 in the magnesium group and 843 in the placebo group), the mean (±SD) age was 69±13 years, 42.6% were women, and the mean pretreatment score on the Los Angeles Motor Scale of stroke severity (range, 0 to 10, with higher scores indicating greater motor deficits) was 3.7±1.3. The final diagnosis of the qualifying event was cerebral ischemia in 73.3% of patients, intracranial hemorrhage in 22.8%, and a stroke-mimicking condition in 3.9%. The median interval between the time the patient was last known to be free of stroke symptoms and the start of the study-drug infusion was 45 minutes (interquartile range, 35 to 62), and 74.3% of patients received the study-drug infusion within the first hour after symptom onset. There was no significant shift in the distribution of 90-day disability outcomes on the global modified Rankin scale between patients in the magnesium group and those in the placebo group (P=0.28 by the Cochran-Mantel-Haenszel test); mean scores at 90 days did not differ between the magnesium group and the placebo group (2.7 in each group, P=1.00). No significant between-group differences were noted with respect to mortality (15.4% in the magnesium group and 15.5% in the placebo group, P=0.95) or all serious adverse events.Prehospital initiation of magnesium sulfate therapy was safe and allowed the start of therapy within 2 hours after the onset of stroke symptoms, but it did not improve disability outcomes at 90 days. (Funded by the National Institute of Neurological Disorders and Stroke; FAST-MAG ClinicalTrials.gov number, NCT00059332.).

  View details for DOI 10.1056/NEJMoa1408827

  View details for Web of Science ID 000349143600007

  View details for PubMedID 25651247

  View details for PubMedCentralID PMC4920545

• Hand Dermatitis: an Allergist's Nightmare CURRENT ALLERGY AND ASTHMA REPORTS Wold, L., Chen, J. K., Lampel, H. P. 2014; 14 (11)

  Abstract

  Hand dermatitis is a common skin complaint. We use our hands to explore our environment; subsequently, our hands are in frequent contact with potential allergens and irritants. Patients with hand dermatitis may present to their allergist with this complaint. Approaching the diagnosis and treatment of hand dermatitis can be challenging, as both internal and external factors may contribute to the overall condition. Furthermore, the differential diagnosis of hand dermatitis is broad and the cause often multifactorial. Obtaining a thorough history and performing a focused examination may help the clinician differentiate between multiple causes of hand dermatitis. Numerous treatment options exist for hand dermatitis, and new potential treatments are in development as well. We aim to provide the allergist with a streamlined toolkit for help in the diagnosis and management of hand dermatitis.

  View details for DOI 10.1007/s11882-014-0474-0

  View details for Web of Science ID 000343644500005

• Erythematous lesions on the trunk and upper extremities. Journal of the American Academy of Dermatology Chen, J. K., Dann, F. 2014; 71 (3): e59-60

  View details for DOI 10.1016/j.jaad.2013.11.026

  View details for PubMedID 25128123

• Drug-induced subacute cutaneous lupus erythematosus associated with doxorubicin JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Chen, J. K., Chen, T. S., Lim, P., Iqbal, M. 2012; 67 (6): E273-E275

  View details for DOI 10.1016/j.jaad.2012.05.021

  View details for Web of Science ID 000312131200015

  View details for PubMedID 23158635

• An overview of clinical and experimental treatment modalities for port wine stains JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY Chen, J. K., Ghasri, P., Aguilar, G., van Drooge, A. M., Wolkerstorfer, A., Kelly, K. M., Heger, M. 2012; 67 (2): 289-?

  Abstract

  Port wine stains (PWS) are the most common vascular malformation of the skin, occurring in 0.3% to 0.5% of the population. Noninvasive laser irradiation with flashlamp-pumped pulsed dye lasers (selective photothermolysis) currently comprises the gold standard treatment of PWS; however, the majority of PWS fail to clear completely after selective photothermolysis. In this review, the clinically used PWS treatment modalities (pulsed dye lasers, alexandrite lasers, neodymium:yttrium-aluminum-garnet lasers, and intense pulsed light) and techniques (combination approaches, multiple passes, and epidermal cooling) are discussed. Retrospective analysis of clinical studies published between 1990 and 2011 was performed to determine therapeutic efficacies for each clinically used modality/technique. In addition, factors that have resulted in the high degree of therapeutic recalcitrance are identified, and emerging experimental treatment strategies are addressed, including the use of photodynamic therapy, immunomodulators, angiogenesis inhibitors, hypobaric pressure, and site-specific pharmaco-laser therapy.

  View details for DOI 10.1016/j.jaad.2011.11.938

  View details for Web of Science ID 000306368600026

  View details for PubMedID 22305042

• A comparison of world wide web resources for identifying medical information ACADEMIC RADIOLOGY Johnson, P. T., Chen, J. K., Eng, J., Makary, M. A., Fishman, E. K. 2008; 15 (9): 1165-1172

  Abstract

  To compare the utility of a search engine, Google, with other medical and non-medical, web-based resources for identifying specific medical information.This institutional review board-approved case cross-over study randomly assigned 89 medical student volunteers to use either Google or any other web-based resource (excluding Google) to research 10 advanced medical questions in a multiple choice exam. Primary outcome measures were resource efficiency (inversely related to number of links used to identify the correct answer for each question) and correctness (number of correct answers/total number of questions answered). For Google searches, the sites providing the information in question were also evaluated.The most frequently selected non-Google resources were Yahoo (n=531), Ask.com (n=110), and the interactive encyclopedia Wikipedia.com (n=74). Google was more efficient than all other resources (1.50 vs. 1.94 mean links, P<.0001), with no significant difference in correctness (97% [756/780] vs. 96% [747/780], P=.16). After a Google search, the four most common categories of sites that provided the correct answer were dictionary/encyclopedia sites, medical websites, National Library of Medicine resources, or journal websites. Yahoo was less efficient than Google (1.90 vs. 1.54 mean links, P<.0001). However, non-Google search engines were more efficient than web sites (eg, Wikipedia, medical websites) and PubMed (1.87 vs. 2.54 mean links, P=.0004).Google is an efficient web resource for identifying specific medical information, by guiding users to an array of medical resources.

  View details for DOI 10.1016/j.acra.2008.02.010

  View details for Web of Science ID 000259051700011

  View details for PubMedID 18692758