Peer review is an effective screening process to evaluate medical manuscripts.

Objective.-To measure the effectiveness of peer review as a screening process to evaluate medical manuscripts. Design.-Retrospective. Setting.-The editorial office of the American Journal of Surgery (AJS). Method.-A MEDLINE search was conducted of publications from 1984 to 1992 for manuscripts that were identical or similar to those rejected by AJS between January and December 1989. Manuscripts that were submitted to AJS by foreign authors were excluded because of the presumed difficulty in tracking foreign-language publications. Main Outcome Measures.-The percentage of manuscripts rejected by AJS that were subsequently published in journals indexed by MEDLINE, the time from rejection to ultimate publication, and the journal of publication. The reasons for rejection were also documented. We assumed that the majority of rejected manuscripts would be published within 3 years after rejection. Results.-One hundred twenty-five manuscripts submitted by North American authors were rejected by AJS in 1989, and 62% were not subsequently published in another core medical journal during the study period. The average duration between rejection and later publication was 17 months. Of those manuscripts subsequently published, 54% appeared in general surgical journals, including 12% that were revised, reevaluated, and later accepted by AJS. Twenty-nine percent of the rejected manuscripts were published in specialty medical journals, 10% in state and local journals, and the remainder in general medical journals. Twenty-eight percent of the authors of rejected manuscripts had previously and subsequently published manuscripts on very similar subjects. Conclusions.-Our data indicate that the review process serves as a sieve and influences whether manuscripts are published in core medical journals. This was demonstrated by the fact that rejected manuscripts often were not published in other indexed medical journals.