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.