Outcome instrument adoption over time

A stacked count of papers per year that mention a known outcome instrument (EHP-30 quality-of-life questionnaire, VAS / NRS pain scales, MUSA imaging criteria, rASRM / Enzian / AFS staging systems, the Biberoglu-Behrman score, and the COS-Endo-2020 core outcome set).

The COS-Endo-2020 inflection in 2020 is the field's single biggest reporting-infrastructure advance: a published core outcome set should drive consistent reporting across trials. Watch the green band — if it doesn't grow, the field hasn't actually adopted the standard.

Source: papers.outcome_instruments array, populated by the abstract pattern-matching tagger in endo_lab/normalize/tag_outcomes.py. Some papers use multiple instruments; they're counted in every band they appear in. The current year is excluded — partial-year data would skew the trend.