Limitations
Citation analyses are prone to certain types of biases. Across many institutions, particularly in the USA, some articles may receive additional citations due to self-citations. This phenomenon has also been noted in other citation analyses and was attributed to preferential citation of ’local research’ and tendency to integrate research in clinical practice.[1] Similarly, by limiting the scope of our search to the English language alone may further affect the self-citation phenomenon.
Additionally, the earliest assessed manuscript dates back to 1982; older publications would have had a longer duration to accumulate citations and it may take a certain amount of time for an influential manuscript to accrue citations due to lead time. However, given that the top 10 cited manuscripts were all published between 2002 and 2015, publication time bias might not be a significant limitation. Finally, certain authors may be under-represented as only first and the senior author is assessed despite most manuscripts being authored by multiple researchers.