Title:
Identification of additional trials in prospective trial registers for Cochrane systematic reviews.

Abstract:
Publication and selective outcome reporting bias are a threat to the validity of systematic reviews. Extensive searching for additional trials in prospective trial registers could reduce this problem. We have evaluated how authors of Cochrane systematic reviews currently make use of trial registers as an additional source for the identification of potentially eligible trials.
We included 210 systematic Cochrane reviews of interventions published between 2008 and 2010 of which the protocol was first published in 2008. When prospective trial registers were searched we recorded the names of the register(s), the authors' motive(s) and if they yielded any extra trials. In 80 reviews (38.1%) the authors had searched in one or more prospective trial register(s) of which 55% had searched in overlapping search portals and individual registers. Most frequently assessed were the MetaRegister (66.3%) and Clinicaltrials.gov (60%) which is in sharp contrast of other registers or portals like the WHO ICTRP Search Portal (20%). Reported motives to use registers were to identify ongoing trials (83.3%), to identify unpublished outcomes or trials (23.5%), to identify recently published trials (11.8%), or to identify any relevant trial (3.9%).In 28 reviews (35%) the authors had selected (ongoing) trials identified in trial registers as potentially eligible.
Trial registers as an additional source of information are gaining acknowledgement amongst Cochrane reviewers. Nevertheless, searches seem to be inefficient as overlapping databases are frequently consulted, while the WHO ICTRP Search Portal that includes the data from all approved registers worldwide is being underused. Moreover, the emphasis is now on the identification of ongoing trials, although the prospective registers offer a broader potential. Further familiarity of registers and guidance how to search and to report will help to implement this as a common method and utilize the full potential of prospective trial registers for systematic reviews.