Authors Of Systematic Reviews Research Articles

An Analysis of the Evidence Informing Clinical Practice Guidelines in the Management and Treatment of Breast Cancer

ObjectiveThe aim of this study was to assess the methodological quality and accuracy of reporting within systematic reviews (SRs) that provide evidence to form clinical practice guidelines (CPGs) in the management and treatment of breast cancer. MethodsThe 5 included CPGs for breast cancer management among National Comprehensive Cancer Network and European Society for Medical Oncology were searched for all SRs and meta-analyses. The characteristics of each study along with their methodological reporting were extracted from each SR using the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) tools. Our second objective was to compare SRs produced by Cochrane groups vs non-Cochrane. ResultsOur study included 5 CPGs for the management of breast cancer, containing 1341 total references with 69 being unique SRs we analyzed. PRISMA completeness percent had a mean 76.3% (n = 69), while AMSTAR-2 completeness score mean was 66.5% (n = 59). Cochrane SRs were found to adhere far better to PRISMA (0.91 vs. 0.74) and AMSTAR-2 (0.95 vs. 0.62) guidelines compared to the non-Cochrane SRs. ConclusionThe reporting quality of SRs that underpin CPGs in breast cancer management widely varies. We recommend that authors of SRs adopt a more uniform approach in assessing the quality of reporting within their studies. In addition, CPGs should use a more standardized method to seek out evidence to establish their recommendations. With improved reporting, clinicians may have increased confidence in CPGs and thus increased utilization of CPGs in clinical decision making.

Pooling of cohort studies and RCTs affects GRADE certainty of evidence in nutrition research

BackgroundThere is a little empirical evidence of the impact of pooling randomized controlled trials (RCTs) and cohort studies (CSs) on the certainty-of-evidence. To evaluate the hypothetical-scenario of pooling bodies-of-evidence from RCTs with matched bodies-of-evidence from CSs on the certainty-of-evidence. MethodsWe extracted GRADE ratings of bodies-of-evidence from RCTs in Cochrane reviews, and rated the certainty-of-evidence from matched bodies-of-evidence from CSs. We then evaluated the impact of pooling both bodies-of-evidence on the overall certainty-of-evidence, and on individual GRADE domains. ResultsFourty-two pooled bodies-of-evidence were rated, ranging from very-low (bodies-of-evidenceRCTs: 9.5%; bodies-of-evidenceCSs: 40.5%; pooled-bodies-of-evidence: 0%) to low (bodies-of-evidenceRCTs: 38.1%; bodies-of-evidenceCSs: 45.2%; pooled-bodies-of-evidence: 19.1%), moderate (bodies-of-evidenceRCTs: 33.4%; bodies-of-evidenceCSs: 14.3%; pooled-bodies-of-evidence: 57.1%), and high (bodies-of-evidenceRCTs: 19%; bodies-of-evidenceCSs: 0%; pooled-bodies-of-evidence: 23.8%). Certainty-of-evidence was downgraded mostly for imprecision and risk of bias for bodies-of-evidence from RCTs, and for risk of bias and inconsistency for bodies-of-evidence from CSs. Pooling both bodies-of-evidence mitigates rating down for imprecision compared to bodies-of-evidence from RCTs and inconsistency compared to bodies-of-evidence from CSs. ConclusionOur hypothetical study suggests that pooling both bodies-of-evidence would reduce the amount of very-low and low certainty-of-evidence ratings, but how to integrate RCTs and CSs and whether or not to pool these bodies-of-evidence requires proper guidance before systematic review authors or guideline developers should consider this approach.

Quality of the Systematic Reviews in Cochrane Gynecological Cancer Group and Their Understudied RCTs.

Gynecological cancers are common neoplasms in clinical settings with a high impact on the economy of communities. The medical literature is an essential resource to guide clinical decision-making, and misconduct in researches undermines the credibility and integrity of research in general. We aimed to evaluate the quality of Cochrane gynecological cancers reviews and their understudies RCTS among the different biases dimensions. This cross-sectional analytical study was performed on 118 systematic reviews published by the Cochrane gynecological cancers Group up to June 2021. The risk of bias was assessed in each Cochrane survey using the Joanna Bridges Institute (JBI) critical assessment tool consisting of 11 questions. The JBI checklist for systematic reviews and research syntheses is available at https://jbi.global/critical-appraisal-tools. After a systematic critical evaluation of the reviews and meta-analysis, we extracted a different bias from all of their understudied RCTs examined in these systematic reviews, which were evaluated by systematic review authors using a standard bias risk tool developed by the Cochrane Group. Cochrane gynecological cancers reviews had high quality based on appraise results using the JBI appraisal checklist. In addition, all of the included studies used PRISMA standards for reporting their results. However, in their understudied RCTs, the most prevalent risk of bias was unclear selection bias (allocation concealment) and performance bias (blinding of participants and personnel). Also, the highest risk of bias was blinding participants and personnel (performance bias) and incomplete outcome data (attrition bias). Our results showed that the lowest risk of bias was incomplete outcome data (attrition bias) and random sequence generation (selection bias). Although most Cochrane gynecological cancers reviews had high quality, unclear performance bias was the highest in their understudied RCTs, indicating structural deficiencies. The online version contains supplementary material available at 10.1007/s13224-022-01655-6.

GRADE summary of findings tables enhanced understanding of values and preferences evidence

ObjectivesWe conceptualize patient values and preferences as the relative importance of health outcomes (RIO) which are often obtained through utility elicitation research. A transparent and structured approach to present synthesized RIO evidence and the certainty of this evidence is needed. This study aims to adapt the summary of findings (SoF) table to describe the RIO. Study Design and SettingWe performed three interactive workshops with a protype version of the SoF table for RIO, evidence adapted from the SoF table for intervention effects. We then tested the new format through semi-structured interviews with professionals who interpret RIO evidence (e.g., systematic review authors and guideline developers). ResultsWe adapted the SoF table for the presentation of RIO evidence. This SoF table may be easy to use, but bears one risk: some participants misunderstood the utility information and the variability around the RIO. We added a visual analogue scale to clarify the concept of utilities. ConclusionThrough a multi-stage process including brainstorming sessions and interviews, we adapted the SoF table to present RIO evidence. This table may enhance understanding of evidence synthesis of values and preferences, facilitating the incorporation of this type of evidence in decision-making.

Strengthening systematic reviews in public health: guidance in the Cochrane Handbook for Systematic Reviews of Interventions, 2nd edition.

Decision makers in public health practice and policy rely on access to trustworthy, relevant, synthesized evidence. The second edition of the Cochrane Handbook for Systematic Reviews of Interventions ('the Handbook') reflects a major revision in guidance for authors of systematic reviews, incorporating a decade of methodological development and a number of significant changes to previous recommendations. This paper aims to highlight new guidance that addresses a number of key methodological challenges for authors of systematic reviews in public health. The revised Handbook includes guidance on framing public health research questions for synthesis, considering equity, intervention complexity, risk of bias assessment and synthesis methods other than meta-analysis. Reviews of public health interventions frequently encounter the types of methodological complexity addressed in this new guidance. We hope that readers will find that the Cochrane Handbook includes detailed and thoughtful guidance on both conceptualizing and executing systematic reviews relevant to public health questions. Considering the available methods guidance will, we hope, provide support for authors of public health reviews to tackle the challenges they encounter, strengthen their analysis and provide useful answers to the important questions asked by stakeholders and users of public health evidence.

Preferred Methods of Measuring Work Participation: An International Survey Among Trialists and Cochrane Systematic Reviewers

Purpose Heterogeneity in work participation (WP) outcomes measurements hampers large scale evidence synthesis in systematic reviews of trials. In this survey we explore authors’ reasons for choosing specific WP outcomes and their measurement methods, including employment status, absence from work, at-work productivity loss, and employability. Methods We contacted authors of 260 trials and 69 systematic reviews and asked closed and open-ended questions about previously used WP outcomes and measurement methods as well as their opinion on the best way to measure WP. Results In total, 91 authors from a wide range of professional backgrounds completed the survey. The majority of authors (86%) chose WP outcomes based on their use in previous similar studies. In most studies (88%), patients had not been involved in the process of selecting the WP outcome. Authors judged feasibility to be an important factor for choosing a measurement instrument (67%). Additionally, valid measurement tools should be available, easy to administer and not too time consuming. Although authors preferred registry data for long term follow-up, the availability and validity of registries was seen as a barrier. Most of the reviewers (72%) struggled to pool data because of variation in follow-up times and cut off points and varying definitions of work outcomes. Almost all (92%) respondents support the use of a Core Outcome Set for Work. Conclusions There is strong support from authors of trials and systematic reviews to develop a core outcome set on work participation outcomes for the evaluation of interventions.

Accuracy of the European Society of Cardiology 0/1-, 0/2-, and 0/3-hour algorithms for diagnosing acute myocardial infarction.

Accuracy of the European Society of Cardiology 0/1-, 0/2-, and 0/3-hour algorithms for diagnosing acute myocardial infarction.

Amoxicillin Treatment of Children With Community-Acquired Pneumonia

Amoxicillin Treatment of Children With Community-Acquired Pneumonia

Complex interventions

ABSTRACT Methods of analysis in systematic reviews of interventions continue to develop as authors seek to answer questions about not only whether interventions work, but how and why they work. As our knowledge improves about how complexity in intervention design, implementation and context explains the variation in the association between interventions and outcomes, systematic reviewers increasingly seek to understand this complexity. This article explores how authors of systematic reviews can through their analysis provide the evidence that supports our understanding of how sport and exercise psychology interventions are intended to work and how complexity in the interventions themselves and in the environment they are introduced into may explain the variation in their impacts. It identifies key methods and tools to support reviewers to understand and analyse complexity in interventions, illustrated with examples from sport and exercise psychology. While complexity can be challenging to incorporate into an analysis of interventions in a systematic review, it is an important step for reviewers to take to make sense of large and complex bodies of evidence and to inform the efficient development and adaptation of interventions.

Evaluating the relationship between industry sponsorship and conflicts of interest among systematic review authors on treatments for cannabis use disorder

Background: Cannabis is the most commonly used illicit drug worldwide. In addition to potential adverse effects, an estimated 9% consistent cannabis users are likely to become dependent and may develop a cannabis use disorder (CUD). Methods: This cross-sectional study developed a search strategy using Ovid, MEDLINE, and Ovid Embase for systematic reviews and meta-analyses focused on CUD treatment in June 2020. These reviews were evaluated for conflicts of interest (COIs) per previously developed classification scheme. Our primary objectives were to (1) evaluate the presence of disclosed or undisclosed COI of systematic review authors, regarding treatment of CUD; and (2) determine whether overall summary effect estimates, narrative results and conclusions were influenced by the presence of disclosed or undisclosed COIs among systematic review authors. Results: Our systematic search returned 560 articles which 9 systematic reviews were eligible for data extraction. We found 77.8% (7/9) contained at least one author with a COI. From the 51 authors included, 29.4% (15/51) were found to have a COI. Forty-four percent (4/9) were funded, 22.2% (2/9) were not funded, and 33.3% (3/9) had no funding statements. Out of the 7 systematic reviews with one or more authors containing COI, 14.2% (1/7) included results favoring the treatment group and 28.6% (2/7) included conclusions favoring the treatment group. Our results showed no significance between funding source and results (p = 0.429) or conclusions. Additionally, we found no significance between the presence of COIs with the favorability of results (p = 0.56) or conclusions. Conclusion: Multiple studies favored the treatment of cannabis-containing products, even though COIs were found in the majority of the systematic reviews. COIs have the ability to sway results of a study, which can affect clinical decision-making. Stricter guidelines should be enforced among authors displaying COIs in systematic reviews studying CUD treatment.

GRADE guidance 24 optimizing the integration of randomized and non-randomized studies of interventions in evidence syntheses and health guidelines

Background and ObjectiveThis is the 24th in the ongoing series of articles describing the GRADE approach for assessing the certainty of a body of evidence in systematic reviews and health technology assessments and how to move from evidence to recommendations in guidelines. MethodsGuideline developers and authors of systematic reviews and other evidence syntheses use randomized controlled studies (RCTs) and non-randomized studies of interventions (NRSI) as sources of evidence for questions about health interventions. RCTs with low risk of bias are the most trustworthy source of evidence for estimating relative effects of interventions because of protection against confounding and other biases. However, in several instances, NRSI can still provide valuable information as complementary, sequential, or replacement evidence for RCTs. ResultsIn this article we offer guidance on the decision regarding when to search for and include either or both types of studies in systematic reviews to inform health recommendations. ConclusionThis work aims to help methodologists in review teams, technology assessors, guideline panelists, and anyone conducting evidence syntheses using GRADE.

Evaluation of Industry Relationships Among Authors of Systematic Reviews and Meta-analyses Regarding Ménières Disease.

To quantify the presence of conflicts of interest (COI) in SRs and MAs of Ménières disease treatment and identify any related secondary characteristics of these articles. A search was conducted on May 28, 2020 to search MEDLINE and Embase databases for SRs or MAs pertaining to Ménières disease published between September 1, 2016 and June 2, 2020. A risk of bias assessment was performed using the Cochrane Collaboration risk of bias assessment criteria. A total of 13 systematic reviews conducted by 49 authors met the inclusion criteria. Of the 49 authors, 7 (14.3%) were found to have some form of COI. Of these 7 authors, 1 (14.3%) completely disclosed all COI within the SR, 1 (14.3%) disclosed one or more COI but were found to have an additional undisclosed COI, and 5 (71.4%) were found to have only undisclosed COI. One of 2 industry funded SRs (50%) had a high risk of bias, and 1 (50%) of the non-industry sponsored SRs were found to have a high risk of bias. Overall authors of SRs pertaining to Ménières disease appear to be properly disclosing COI at higher rates than other fields of medicine; however, further room for improvement has been noted.

Conflicts of Interest Among Authors of Systematic Reviews Regarding the Management of Chronic Non-Cancer Pain with Opioids Analgesics.

We sought to determine whether author conflict of interest (disclosed or undisclosed) or industry sponsorship influenced the favorability of reporting of systematic reviews and meta-analyses investigating the use of opioid analgesics for the management of chronic non-cancer pain. Our search included the MEDLINE (Ovid) and Embase (Ovid) databases. Study sponsorship was determined using the funding statement provided in each systematic review. Author COI information was extracted from the COI disclosure statement. This information was cross-referenced with information available on the CMS Open Payments Database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office (USPTO), and previously published COI disclosures. Eight systematic reviews authored by 83 authors were included. Of these authors, 19 (23.0%) were found to have a COI, of which the majority (17/19; 89.5%) had at least one undisclosed COI. Despite nearly one-quarter of authors having a COI, we found no association between the presence of a COI and the favorability of results (P = 0.64) or conclusions (P = 0.07). COI are common and frequently undisclosed among systematic review authors investigating opioid analgesics for the management of chronic non-cancer pain. Despite a high prevalence of COI, we did not find that these author-industry relationships had a significant influence on the favorability of results and conclusions; however, our findings should be considered a lower bound estimate of the true influence author COI have on outcomes of pain medicine systematic reviews secondary to the low sample size included in the present study.

Attributes of Travel Destinations that Influence Tourists’ Decisions: A Systematic Review

Aims and Scope | Author Guidelines | Current Issue | Archive | Indexing | Editorial Board | Contact Us Issue 8 | Volume 4 | 2021 Title: Attributes of Travel Destinations that Influence Tourists’ Decisions: A Systematic Review Author(S): Ortaleza, Maricar S. and Mangali, Glen R.* Corresponding Author Affiliation*: Colegio De San Juan De Letran, … Continue reading "International Tourism and Hospitality Journal (ITHJ)"

Association between industry sponsorship and author conflicts of interest with outcomes of systematic reviews and meta-analyses of interventions for opioid use disorder

IntroductionAuthor conflicts of interest (COI) and industry sponsorship may lead to biased research results and conclusions. Considering the direct influence that systematic reviews have on patient care, including the management of patients being treated for opioid use disorders (OUD), these studies should be free of industry bias. Thus, we sought to determine whether a relationship exists between COI and the favorability of systematic review outcomes using a sample of systematic reviews regarding OUD interventions. MethodsWe searched MEDLINE and Embase for systematic reviews and meta-analysis related to OUD treatment. The study team performed all data extraction in a masked duplicate fashion. We searched for undisclosed COI for each systematic review author in 3 databases––the CMS Open Payments database, Dollars for Profs, and the United States Patent and Trademark Office (USPTO). The research team quantified results using descriptive statistics. We evaluated associations between review characteristics using Fisher's exact tests, when possible. ResultsThis article includes seventeen systematic reviews and meta-analyses with 81 authors. We found that 25 authors (30.9%) had some form of COI, and 22 (of 25, 88.0%) authors had an undisclosed COI. However, no significant association existed between COI and favorability of results and conclusions. Notably, two systematic reviews (of 17; 11.76%) were industry-sponsored. Similarly, we found no association between the study sponsor source and the favorability of systematic review results and conclusions. ConclusionsOur results suggest the favorability of systematic review results and conclusions are not influenced by author COI or industry sponsorship. However, nearly one-fourth of authors had an undisclosed COI, further emphasizing the need for standardization and adherence to COI disclosure policies within addiction medicine literature.

Prediction intervals reporting in orthodontic meta-analyses.

SummaryBackgroundA prediction interval represents a clinical interpretation of heterogeneity. The aim of this study was to determine the prevalence of prediction interval reporting in orthodontic random effect meta-analyses. The corroboration between effect size estimates with 95% confidence intervals (CIs) and prediction intervals were also explored.Materials and methodsSystematic reviews (SRs) published between 1 January 2010 and 31 January 2021 containing at least one random effects meta-analysis (minimum of three trials) were identified electronically. SR and meta-analyses characteristics were extracted and prediction intervals, where possible, were calculated. Descriptive statistics and the percentage of meta-analyses where the prediction interval changed the interpretation based on the 95% CI were calculated. Fisher’s exact test was used to examine associations between the study variables and reporting of prediction intervals.ResultsOne hundred and twenty-one SRs were included. The median number of SR authors was 5 (interquartile range: 4–6). The reporting of prediction intervals was undertaken in only 19.0% (N = 23/121) of meta-analyses. Out of 95 meta-analyses, only in 6 (6.3%, N = 6/95) were the 95% CI corroborated by the prediction interval. In 60 meta-analyses (63.3%, N = 60/95) despite a 95% CI indicating a statistically significant result, this was not corroborated by the corresponding prediction interval.ConclusionsWithin the study timeframe, reporting of prediction intervals is not routinely undertaken in orthodontic meta-analyses possibly due to a lack of awareness. In future orthodontic random effects models containing a minimum of three trials, reporting of prediction intervals is advocated as this gives an indication of the range of the expected effect of treatment interventions.

Use of quality assessment tools within systematic reviews in orthodontics during the last decade: looking for a threshold?

To record the prevalence and extent of use of quality assessment/ risk of bias tools in orthodontic systematic reviews and to identify whether systematic reviews authors stipulated a threshold during the evaluation process of the primary studies included in systematic reviews, published across the previous decade and until now. Associations with publication characteristics including the journal of publication, year, the inclusion of a meta-analysis, design of primary studies and others, were sought. Electronic search within 6 orthodontic journals and the Cochrane Database of Systematic Reviews was conducted to identify relevant systematic reviews from 1 January 2010 and 31 December 2020. The outcomes of interest pertained to the use, type and extent of quality appraisal/ risk of bias tools utilized as a standard process within the systematic reviews, and also whether a threshold had been stipulated by the systematic reviews authors. Predictor variables included journal, year of publication, geographic region, number of authors, involvement of a methodologist, type of systematic reviews, inclusion of meta-analysis, type/design of primary studies. A total of 262 systematic reviews were eligible for inclusion, with 41 quality appraisal/ risk of bias sets of tools being described either jointly or in isolation. One-third of the systematic reviews of the present sample (88/262; 33.6%) included a threshold, while this was mostly represented by the stipulation of sensitivity analyses in this respect (64/88; 72.8%). Journal of publication (non-Cochrane systematic reviews versus Cochrane systematic reviews: adjusted odds ratio, OR: 0.04, 95%CI: 0.01, 0.16; P < 0.001) and inclusion of a meta-analysis (adjusted OR: 8.76; 95%CI: 4.18, 18.37; P < 0.001), were identified as significant predictors for preplanning of thresholds. Quality assessment tools for primary studies are largely used and varied in orthodontic systematic reviews, while a threshold-level has been stipulated in only one third. Additional efforts should be endorsed by the scientific community, to embrace more straightforward adoption of the most rigorous reporting guidelines in this respect.

Conflicts of Interest Among Authors of Systematic Reviews and Meta-analyses Investigating Interventions for Melanoma: Cross-sectional Literature Study.

Previous studies have highlighted the potential influence that industry relationships may have on the outcomes of medical research. We aimed to determine the prevalence of author conflicts of interest (COIs) in systematic reviews focusing on melanoma interventions, as well as to determine whether the presence of these COIs were associated with an increased likelihood of reporting favorable results and conclusions. This cross-sectional study included systematic reviews with or without meta-analyses focusing on interventions for melanoma. We searched MEDLINE and Embase for eligible systematic reviews published between September 1, 2016, and June 2, 2020. COI disclosures were cross-referenced with information from the CMS (Centers for Medicare & Medicaid Services) Open Payments database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office, and previously published COI disclosure statements. Results were quantified using descriptive statistics, and relationships were evaluated by Fisher exact tests. Of the 23 systematic reviews included in our sample, 12 (52%) had at least one author with a COI. Of these 12 reviews, 7 (58%) reported narrative results favoring the treatment group and 9 (75%) reported conclusions favoring the treatment group. Of the 11 systematic reviews without a conflicted author, 4 (36%) reported results favoring the treatment group and 5 (45%) reported conclusions favoring the treatment group. We found no significant association between the presence of author COIs and the favorability of results (P=.53) or conclusions (P=.15). Author COIs did not appear to influence the outcomes of systematic reviews regarding melanoma interventions. Clinicians and other readers of dermatology literature should be cognizant of the influence that industry may have on the nature of reported outcomes, including those from systematic reviews and meta-analyses.

Quality appraisal of systematic reviews of interventions for children with cerebral palsy reveals critically low confidence.

To evaluate the methodological quality of recent systematic reviews of interventions for children with cerebral palsy in order to determine the level of confidence in the reviews' conclusions. A comprehensive search of 22 databases identified eligible systematic reviews with and without meta-analysis published worldwide from 2015 to 2019. We independently extracted data and used A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) to appraise methodological quality. Eighty-three systematic reviews met strict eligibility criteria. Most were from Europe and Latin America and reported on rehabilitative interventions. AMSTAR-2 appraisal found critically low confidence in 88% (n=73) because of multiple and varied deficiencies. Only 7% (n=6) had no AMSTAR-2 critical domain deficiency. The number of systematic reviews increased fivefold from 2015 to 2019; however, quality did not improve over time. Most of these systematic reviews are considered unreliable according to AMSTAR-2. Current recommendations for treating children with CP based on these flawed systematic reviews need re-evaluation. Findings are comparable to reports from other areas of medicine, despite the general perception that systematic reviews are high-level evidence. The required use of current widely accepted guidance for conducting and reporting systematic reviews by authors, peer reviewers, and editors is critical to ensure reliable, unbiased, and transparent systematic reviews. What this paper adds Confidence was critically low in the conclusions of 88% of systematic reviews about interventions for children with cerebral palsy (CP). Quality issues in the sample were not limited to systematic reviews of non-randomized trials, or to those about certain populations of CP or interventions. The inclusion of meta-analysis did not improve the level of confidence in these systematic reviews. Numbers of systematic reviews on this topic increased over the 5 search years but their methodological quality did not improve.

Clinical Trial Registry Use in Orthopaedic Surgery Systematic Reviews.

Results from systematic reviews and meta-analyses, which have the highest level of evidence (Level I), often drive clinical decision-making and health policy. Often, unpublished trial data are omitted from systematic reviews, raising concerns about the extent of the reliability and validity of results that have been drawn from systematic reviews. We aimed to determine the extent to which systematic review authors include searches of clinical trial registries for unpublished data when conducting systematic reviews in orthopaedic surgery. Systematic reviews and/or meta-analyses were gathered from the top 5 orthopaedic surgery journals based on the h5-index from Google Scholar Metrics. Systematic reviews that had been published in the Cochrane Database of Systematic Reviews, which requires the inclusion of a clinical trial registry search, served as controls. For the primary outcome, each systematic review from the top 5 orthopaedic journals was screened to determine whether the authors of each study searched for unpublished data in clinical trial registries. We then compared the rate of registry searches with those in the control group. For the secondary analysis, a search of ClinicalTrials.gov was performed for unpublished trial data for 100 randomized systematic reviews. All 38 of the Cochrane systematic reviews (100%) included clinical trial registry searches, while the top 5 orthopaedic journals had only 31 of 480 studies (6.5%) that looked at clinical trial registries. The secondary analysis yielded 59 of 100 systematic review articles (59.0%) that could have included unpublished clinical trial data from ≥1 studies to their sample. Systematic reviews that have been published in the top orthopaedic surgery journals seldom included a search for unpublished clinical trial data. The exclusion of clinical trial registry searches potentially contributes to publication bias within the orthopaedic literature. Moving forward, systematic review authors should include clinical trial registry searches for unpublished clinical trial data to provide the most accurate representation of the available evidence for systematic reviews and meta-analyses.