Changes to manuscripts during the editorial process: characterizing the evolution of a clinical paper.

Biomedical manuscripts undergo substantive change as a result of the peer review and editorial revision processes. To characterize quantitatively problems in manuscripts identified during peer review and changes made to address these problems. Descriptive analysis of manuscripts submitted to and articles published by the Annals of Internal Medicine. A taxonomy of problems that occur in reporting clinical research was developed from analysis of changes made to 7 manuscripts between submission and publication (published October 15, 1996, and November 1, 1996). The taxonomy was used to characterize changes to 12 additional manuscripts (published January 15, 1997, to April 1, 1997). Types of problems necessitating changes to manuscripts during peer review and revision. Changes occurred because of 5 types of problems: too much information, too little information, inaccurate information, misplaced information, and structural problems. Changes most often occurred because information was missing or extraneous. The distribution of changes seemed to be influenced by the type of information involved (such as background or conclusions). The proposed framework may be useful for characterizing quantitatively the effects of peer review and for comparing those effects across editors, journals, and specialties.