Objectives: The purpose of this study was to determine whether the number of bibliographic databases used to search the health sciences literature in individual systematic reviews (SRs) and meta-analyses (MAs) changed over a twenty-year period related to the official 1995 launch of the Cochrane Database of Systematic Reviews (CDSR).Methods: Ovid MEDLINE was searched using a modified version of a strategy developed by the Scottish Intercollegiate Guidelines Network to identify SRs and MAs. Records from 3 milestone years were searched: the year immediately preceding (1994) and 1 (2004) and 2 (2014) decades following the CDSR launch. Records were sorted with randomization software. Abstracts or full texts of the records were examined to identify database usage until 100 relevant records were identified from each of the 3 years. They employ reproducible methodology to identify all relevant studies, assess the validity of their findings, and combine the results to provide conclusive answers to clinical questions [3]. Once the literature has been systematically reviewed, quantitative data from individual studies may be pooled and reanalyzed using established statistical methods [4]. These reports are called meta-analyses (MAs), which are considered a subtype of SRs. The rationale for MAs is that combining samples of individual studies increases overall sample size, thereby improving the statistical power of the analysis and the precision of the estimates of treatment effects [5]. SRs and MAs are foundations of evidence-based medicine, as they rely on balanced inference generated from collated evidence instead of commentaries made by experts, as in the case of narrative reviews [6]. SRs and MAs have become increasingly popular for providing evidence of the effectiveness of medical interventions to support the creation of clinical practice guidelines. In 2010, an average of eleven new SRs or MAs were published each day [7].High-quality SRs require high-quality literature searches and accurate reporting. Searching a single database identifies a maximum of one-third of all relevant articles, and searching more databases may identify only half of all available articles [8]. A search conducted solely in MEDLINE results in database bias, as only 30%-80% of all trials are identifiable through MEDLINE [9]. Although the Cochrane 284