Cited by 168Meta-analysis and systematic reviewsscientometrics and bibliometrics researchInformation Retrieval and Search Behavior

The DOI matches its Crossref record; 29 of the 32 references it cites were found in a registry or an index; none of the 15 sources its claims cite is checked for support yet.

Searching two or more databases decreased the risk of missing relevant studies: a metaresearch study

Open access

Abstract

BACKGROUND AND OBJECTIVES: Assessing changes in coverage, recall, review, conclusions and references not found when searching fewer databases. METHODS: In randomly selected 60 Cochrane reviews, we checked included study publications' coverage (indexation) and recall (findability) using different search approaches with MEDLINE, Embase, and CENTRAL and related them to authors' conclusions and certainty. We assessed characteristics of unfound references. RESULTS: Overall 1989/2080 included references, were indexed in ≥1 database (coverage = 96%). In reviews where using one of our search approaches would not change conclusions and certainty (n = 44-54), median coverage and recall were highest (range 87.9%-100.0% and 78.2%-93.3%, respectively). Here, searching ≥2 databases reached >95% coverage and ≥87.9% recall. In reviews with unchanged conclusions but less certainty (n = 2-8): 63.3%-79.3% coverage and 45.0%-75.0% recall. In reviews with opposite conclusions (n = 1-3): 63.3%-96.6% and 52.1%-78.7%. In reviews where a conclusion was no longer possible (n = 3-7): 60.6%-86.0% and 20.0%-53.8%. The 265 references that were indexed but unfound were more often abstractless (30% vs. 11%) and older (28% vs. 17% published before 1991) than found references. CONCLUSION: Searching ≥2 databases improves coverage and recall and decreases the risk of missing eligible studies. If researchers suspect that relevant articles are difficult to find, supplementary search methods should be used.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In a metaresearch study of 60 Cochrane reviews, searching two or more databases improved coverage and recall and reduced the risk of inappropriate conclusions, but even MEDLINE + Embase + CENTRAL did not achieve total recall. Many references remained unfound, especially older references and those without abstracts.

Key findings

  • Of 2,080 included references, 1,989 (95.6%) were indexed in at least one of MEDLINE, Embase, or CENTRAL, but only 1,724 (83%) could be found by searching M + E + C. Median coverage and recall were highest for M + E + C (98.5% and 90.0%, respectively); single-database median coverage was highest in CENTRAL (91.3%) and single-database median recall was highest in MEDLINE (75.5%).
  • In reviews where conclusions and certainty did not change (n = 44–54 depending on search approach), median coverage ranged from 87.9% to 100.0% and median recall from 78.2% to 93.3%; searching two databases reached >95% coverage and 87.9% recall. In reviews where no conclusion was possible (n = 3–7), median coverage was 60.6%–86.0% and median recall 20.0%–53.8%; in reviews with an opposite conclusion (n = 1–3), coverage was 63.3%–96.6% and recall 52.1%–78.7%.
  • Overall, 356/2,080 (17%) references were not found by any of the seven limited database search approaches. After removing 30 duplicates, of 326 individual not-found references, 91 (28%) were not indexed; among the 235 indexed but not found, 70% had an abstract, 99% were in English, 74% were on cardiovascular topics, and 62% involved nutrition or physical activity interventions. Not-found references were older (28% vs. 17% published before 1991) and more often had no abstract (30% vs. 11%) than found references.
  • Many indexed references not found by M + E + C had no abstract; the paper states that almost a third of studies indexed but not found by searching MEDLINE, Embase, and CENTRAL had no abstract.

Methods

  • This was a sub-study of a larger methodological project. The authors randomly selected 60 Cochrane reviews that had a replicable search strategy, clear conclusions, and a meta-analysis. The gold standard-set was all references in the “References to studies included in this review” sections (2,080 references).
  • They assessed seven limited search approaches: MEDLINE-only, Embase-only, CENTRAL-only, M + E, M + C, E + C, and M + E + C. For each, they calculated database coverage and recall and related these to the original authors’ conclusion categories: same conclusion/same certainty, same conclusion/less certainty, opposite conclusion, and no conclusion possible. Reference list checking was not considered in this sub-study.
  • Data management and analysis used EndNote X8 and Excel 2016. They performed descriptive statistics (mean, median, IQR) and examined unfound references for indexation status, abstract availability, publication date, language, intervention type, and topic; they compared abstract availability and publication date before/after 1991 between found and not-found indexed references.

Limitations

  • The paper states that the relationship between recall and conclusions is not straightforward: unfound references may have belonged to narrative syntheses rather than meta-analyses, affecting recall but not conclusions. It also states that recall was calculated independently of coverage, so a search finding all indexed references could still have low recall if the review contained many nonindexed references.
  • The paper states that limiting indexation checks to MEDLINE-only and Embase-only may underestimate coverage and recall compared with actual search interfaces; using Cochrane reviews may overestimate CENTRAL coverage; and updated reviews may include references added after the original publication. It also states that search strategies were assumed comprehensive and only checked for formal errors, not comprehensiveness or overall quality, so low recall could reflect suboptimal or deliberately specific searches.
  • Evident from the text: the sample was limited to 60 Cochrane reviews, and 2,014/2,080 references (96.8%) were RCTs or quasi-randomized trials, so findings may not generalize to other review types or study designs; as an observational metaresearch study, it cannot establish causality.

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Integrity signals

Registry

Crossref · 10.1016/j.jclinepi.2022.05.022

Cites

29 of 29 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

49 Own result · 15 Own interpretation · 10 Not checked yet · 6 Own method · 2 No basis given

Verify all 15 references — free account
  • It may state two separate claims as one. 26
  • The quote only partly states this claim. 2
  • Probably not a substantial claim. 15
36 of 36
  • The paper relies on this without support.

    The references included in the 60 Cochrane reviews (the gold standard-set) represent all relevant studies for those reviews.

    “From each review, we used all references reported in the ''References to studies included in this review'' section as a gold standard-set to assess 14 different search approaches using a limited number of sources (i.e., the 14 possible combinations of MEDLINE, Embase, CENTRAL with and without screening reference lists).”
    “For this sub-study, we used the same gold standard-set as mentioned above.”
  • The paper relies on this without support.

    The 60 randomly selected Cochrane reviews are representative of Cochrane reviews generally.

    “We randomly selected 60 Cochrane reviews that included a replicable search strategy, had clear conclusions, and reported a meta-analysis [12].”
  • The paper relies on this without support.

    A change in a Cochrane review's conclusion when searching fewer databases indicates an inappropriate conclusion.

    “Searching at least two databases improves coverage and recall and decreases the chances of making an inappropriate conclusion in a review.”
  • The paper relies on this without support.

    The database indexation status at the time of the original search can be accurately determined using database-specific identifiers.

    “For each reference, we noted the availability in the target databases using the database-specific identifiers.We used these identifiers to determine if available studies were found by the original search strategies.”
  • The paper relies on this without support.

    The intervention type classification (pharmacological vs nonpharmacological) is valid and meaningful.

    “We determined the clinical topic of each review and categorized all reviews according to the type of intervention (pharmacological or nonpharmacological).”
  • The paper relies on this without support.

    The original conclusions of the Cochrane reviews are a valid benchmark for assessing whether limited searches change conclusions.

    “Then, we asked the original authors whether the resulting summary of findings tables would alter their conclusions.”
  • The authors state this as an assumption.

    The search strategies of the included Cochrane reviews are comprehensive and of high quality, so that the references they include can serve as a gold standard.

    “We assumed that these would be comprehensive and of high quality to serve as gold-standard [30].”
  • The paper relies on this without support.

    The 60 Cochrane reviews and the references they included are representative of systematic reviews and their included studies more generally.

    “Characteristics of references of studies included by the 60 Cochrane reviews”
8 of 8

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Citations

Cites

Show all 32 references

Research works printed but not linked: 1

  1. Geretsegger, 2014, Music therapy for people with autism spectrum disorder. Cochrane Database of Systematic Reviews, Cochrane Database Syst Rev, 2014, CD004381

Cited by

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Metadata

Authors
Ewald, H., Klerings, I., Wagner, G., Heise, T. L., Stratil, J. M., Lhachimi, S. K., Hemkens, L. G., Gartlehner, G., Armijo-Olivo, S., & Nussbaumer-Streit, B.
Affiliations
  • University of Basel (CH)
  • Universität für Weiterbildung Krems (AT)
  • University of Bremen (DE)
  • Ludwig-Maximilians-Universität München (DE)
  • University of Alberta (CA)
Corresponding author
Ewald, Hannah
Venue
Journal of Clinical Epidemiology
Publisher
Elsevier BV
Published
2022-09
Volume
149
Pages
154-164
ISSN
0895-4356 (ISSN-L)
OpenAlex
W4281701339
Cited by
168
References
32
Citations by year
2026: 61 · 2025: 54 · 2024: 44 · 2023: 9
FWCI
16.15
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Epidemiology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion, cc-by-nc-nd)
  • Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by-nc-nd)
  • Library Osnabrück University (Hochschule Osnabrück) (submittedVersion, cc-by-nc-nd)
Topics
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
  • Social Sciences › Library and Information Sciences › scientometrics and bibliometrics research
  • Physical Sciences › Computer Science › Information Systems › Information Retrieval and Search Behavior
Keywords
database searching, search recall, missing studies, bibliographic database indexing, MEDLINE, Embase, Central
MeSH terms
Abstracting and Indexing, Humans, Databases, Bibliographic, Databases, Factual, MEDLINE, Information Storage and Retrieval

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