Just the Facts

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A point of care resource designed primarily for primary care clinicians.

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What is the Cochrane Database of Systematic Reviews (CDSR)?

The CDSR is a database of systematic reviews created by the Cochrane Collaboration, an international organization of expert groups. The Cochrane Collaboration has developed a strict methodology detailing how their topic reviews are performed, which they use to make best practices recommendations for clinicians. Reviews are created in a structured format and developed from an extensive and systematic search of the literature (generally randomized controlled trials), and in fact the Collaboration has built the huge Cochrane Register of Controlled Trials to ensure completeness. Those RCT’s are subjected to detailed statistical analysis following established EBM principles, and the results of the various available trials are compared and combined to provide authoritative conclusions useful in clinical settings.

Who is the intended audience for the CDSR?

The Cochrane Collaboration bills itself as providing authoritative EBM based medical information for both health care providers and for patients.  Most of the reviews are fairly technical, however, and many patients may find this daunting.  Medical professionals can use the CDSR to bring EBM to the bedside, since much of the time consuming work of EBM has been done for them.

When should I use the CDSR?

The CDSR is designed to answer clinical (PICO) questions on therapy or prevention interventions only.  Going to the CDSR before doing a general MEDLINE search is a good habit to get into, since a MEDLINE search will locate isolated articles that will require analysis by the medical professional personally, a time consuming process.  Furthermore, a MEDLINE search may miss important articles that will have been picked up by the Cochrane Collaboration systematic review process.

What are the limitations to the CDSR?

The Cochrane Collaboration began in 1993, and since that time, the number of reviews within the CDSR has grown to around 2500 entries.  However, internal estimates by the Collaboration suggest that 10,000 entries would be required to cover most major medical conditions, with half of those reviews requiring an update annually.  The CDSR is therefore incomplete at this point, but is constantly growing, as is the base of medical professionals working the project.  Current timetables suggest that the project may reach its goal of comprehensive topic coverage within the next decade or so.  Planned reviews that are not yet finished are labeled by the Collaboration as "protocols."

The CDSR  is also not a great resource for background level research on a medical topic, because it limits itself to the systematic EBM based conclusions and statistical analysis in its methodology and does not provide pathophysiology or other basic information regarding a medical condition.  Medical textbooks, review articles or UpToDate would be better choices for background research.

What other resources are similar to the CDSR?

There are several other resources that are attempting to create similar EBM based summaries to Cochrane, but none are as well developed or comprehensive. ACP Journal Club provides synopses of specific studies and reviews, but does not do any kind of overarching meta analysis. DARE does something similar, synopses of review articles only, but again on an article by article basis. Realistically, the major competitor to CDSR in the hearts and minds of medical professionals is UpToDate. In general, UpToDate is a much more readable resource, and while it has EBM pretensions, UpToDate does not follow the kind of systemized review process employed by the Cochrane Collaboration. UpToDate is therefore a less reliable source of the answers to PICO questions and is more appropriate as a background resource.