Objective
Assessing changes in coverage, recall, review conclusions and references not found when searching fewer databases.
Study design and setting
In 60 randomly selected 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
... [Show full abstract] certainty. We assessed characteristics of unfound references.
Results
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.