Review of the 100 Most Cited Articles in Burns from 2014–2024: A Bibliometric Analysis

1. Introduction

Burns can be associated with extensive soft tissue injuries and contribute to significant morbidity and mortality. Research on the management of burns has garnered significant interest over the last decade, as demonstrated in Figure 1. However, identifying the articles that have significantly impacted and advanced the field remains challenging. While the aim of academic research is the generation of robust literature with high level of evidence, only a minority of publications substantially contribute to the existing body of scientific knowledge.

The importance of articles published in a particular domain is echoed in the quantity of citations received from peers. Citations serve as an acknowledgement by the authors to colleagues for previous published endeavors in that academic domain. The more times an article is cited, the greater the presumed significance of the article in that particular academic domain. In this context, a bibliometric analysis can be a valuable tool for identifying impactful studies. Therefore, this study focuses on the 100 most cited articles published in the field of burn management from the past decade, aiming to provide insight into significant advancements and key contributions.

2. Materials and Methods

The Web of Science database (Clarivate, Philadelphia, USA) was utilized to perform a comprehensive search and collate articles in the field of burn management published between January 2014 to September 2024 with the highest number of citations. Three authors independently conducted the search using the keyword "burn” to identify all articles in the English language. Articles unrelated to the field of burn management were excluded after a thorough review of the full text of each article. A preliminary list of articles was compiled by combining the results from all three authors. Discrepancies were resolved through a consensus conference of all authors, culminating in the final list of 100 articles relevant to the field of burn management with the highest number of citations. The methodology was based on the approach previously described by Joyce et al [1]. Each article was systematically analyzed to extract descriptive data, including the topic, the journal and publication year, the authors, institutional affiliations and country of origin. This study was conducted in accordance with the World Medical Association Declaration of Helsinki and the Good Clinical Practice guidelines.

3. Results

In the past decade, the 100 most cited papers in the field of burn management as demonstrated in Table 1, received an average of 203 citations with a standard deviation of 117 citations. The article with the most citations garnered 754 citations, while the article with the least citations had 107 citations.

The top 100 articles with the highest citations in burn management in the past ten years were distributed across 59 source journals. Table 2 demonstrates the prominent ten journals with impact factors ranging from 2.0 to 98.4, that contributed to 44% of these articles. Further analysis of this list demonstrates that 60% of these articles constituted “review articles” and 66% of these articles were available “open access”. Elsevier and Springer Nature published 53% of these articles. Funding was a significant feature, with 20% of the articles receiving financial support from the National Institutes of Health (NIH), USA and a further 20% of the articles receiving financial support from the United States Department of Health and Human Services.

Authorship analysis revealed that seven authors contributed to 29% of the 100 most cited articles in burns management from 2014 to 2024 as demonstrated in Table 3. A gender predilection was noted, with only 23% of contributions from female authors. Geographically, 42% of the articles originated from European authors, followed by 28% from North American authors and 23% from Asian authors, as demonstrated in Fig 2. Contributions came from a variety of disciplines, with plastic & reconstructive surgeons and general surgeons making equal contributions to the literature on burn management. Additional contributions were notes from trauma surgeons, pain and rehabilitation physicians and academics or researchers in basic science and pharmacotherapy.

4. Discussion

This bibliometric analysis of burn management has identified the 100 most cited articles published over the past decade in English language literature. Our findings offer valuable insights into significant advancements in this field and highlight key contributions and trends. This list includes major randomized control trials, systematic reviews, and clinical consensus guidelines that contribute an integral knowledge base for the burn surgeon.

Wound care and dressing innovations were a prominent theme that was noted in 17 of the top 100 most cited articles, particularly focussed on rapid healing and prevention of infections [43,76,98]. The most cited article, with 754 citations, is a review of natural and synthetic polymers for wounds and burns dressing published in the International Journal of Pharmaceutics ². Polysaccharides (alginates, chitin, chitosan, chondroitin, heparin), proteoglycans and proteins (collagen, eggshell membrane, fibrin, gelatin, keratin, silk fibroin) are natural polymers used in wounds and burns management because of their biocompatibility, biodegradability and similarity to macromolecules recognised by the body. Synthetic polymers, such as tissue-engineered skin, have been utilised in regenerative medicine for the treatment of severe skin defects or partial-thickness burn injuries.

Critical care management of burns was another prominent theme. The article with the most citations (404) in this domain explored intensive care unit acquired weakness (ICUAW), a de novo form of muscle weakness, in a substantial number of patients admitted to the ICU with severe burns and other trauma ⁷. Other articles in this theme examined fluid resuscitation of critically ill burns patients, nutrition and metabolism as well as prevention and management ICU and hospital acquired concurrent infections ^{5, 62, 71}. Another major area of research was the use of virtual reality for pain management. The article with the most citations (200) in this domain was a comprehensive literature review that explored the use of virtual reality as a distraction tool to alleviate pain and distress during medical procedures such as burns debridement and dressing change ³⁶. Other publications on this theme explored the use of virtual reality for pain and anxiety management in the paediatric burn population ^{69, 70}.

This study sheds light on advances since the initial work by Joyce et al that explored the 100 most influential articles in the field burn management from 1945-2013 [1]. Historically, the prominent publications were limited to 27 source journals featuring Annals of Surgery, Journal of Trauma, Injury, Infection and critical care, Lancet, Burns and New England Journal of Medicine [1]. In the past decade, impactful work has been distributed across a broader range of journals, reflecting the rise of open-access publishing and increased digitisation of research. Prominent publications spanned 56 source journals featuring Critical Care, Burns & Trauma and Burns, with ongoing contribution from Lancet and Annals of Surgery to prominent burns literature.

The 100 most influential articles in burns from 1945 to 2013 ranged from 104 citations (least cited) to 746 citations (most cited) [1]. This is similar to the 100 most cited articles from 2014 to 2024, which ranged from 105 (least cited) to 754 (most cited). However, this is not similar to bibliometric analyses in other fields during the same period, such as hand surgery, which ranged from 47 (least cited) to 179 (most cited) [103].

While journal impact factor is often used as a measure of quality, it does not necessarily determine the journal’s contribution to the list of top 100 articles with the most citations. The impact factor is a measure the quality of academic journals within an academic domain and is derived by dividing the number of citations from a journal by the number of articles published in that journal over two years [102]. Most of these metrics have significant limitations in that they attribute greater significance to work in academic domains with a larger audience. For example, Lancet (impact factor 98.4) appeals to the wider medical audience, while journals such as Annals of Surgery (impact factor 10.1) and Burns & Trauma (impact factor 6.3) enjoy a smaller subspecialised readership, yet both have contributed substantially to the burn’s literature.

This study has numerous limitations that are inherent to all bibliometric analyses. Citations were utilized as a substitute to comprehend the impact and scientific merit of published articles. Citations may reflect an author's recognition of the study's relevance to their research. However, it should be noted that publications from 2023-2024 were not included in this list due to insufficient time for citation accumulation. While citation bias and self-citation can exaggerate bibliometric results, non-English articles can have limited visibility. Despite these limitations, this bibliometric analysis offers a snapshot of impactful research in burn management. It highlights key advancements and provides researchers, surgeons, and allied health professionals with a curated reference of influential studies to inform practice and future investigations.

5. Conclusions

This bibliometric analysis provides an insightful overview of the 100 most cited articles in burn management from 2014 to 2024. These articles reflect significant advancements and key contributions across diverse areas including wound care, critical care management and pain relief innovations. By highlighting the most impactful research, this study serves as a valuable resource for surgeons, researchers and allied health professionals, offering insights into the foundational work shaping modern burn care. While bibliometric analysis has inherent limitations, it remains a valuable tool for comprehending the evolution of scientific progress in this field.