Objectives Guideline developers, healthcare decision makers, and researchers need to identify reliable systematic reviews (SRs) to inform evidence-based medicine (EBM) and underpin guidelines. At the start of this decade, Bastian et al. highlighted the challenge of keeping up with new publications, when 11 reviews were being published daily and this is coupled with difficulties in finding SRs through time-intensive, traditional literature searches. We sought to estimate the current publication rate of SRs and to examine Epistemonikos as a method for identifying SRs by considering transparency of contributors and SR identification methods, researcher awareness and confidence, and its value as a means of finding SRs.

Methods We reviewed the Epistemonikos website and searched Pubmed, Embase, and the Cochrane Library for ‘Epistemonikos’ to examine awareness. We compared basic search strategies in Epistemonikos with the comprehensive search strategy from an overview of SRs and screened records solely identified in Epistemonikos to determine their eligibility for the overview. We estimated the number of SRs published annually between 1990 and 2018 through various searches, including Epistemonikos.

Results We noted no major concerns for potential conflicts of interest in the compilation of Epistemonikos, but a fuller process description for identifying SRs would be helpful. The word Epistemonikos appeared in 226 abstracts in Pubmed or Embase, and in the full text of 24 of 7960 (0.3%) full Cochrane reviews. Our basic search in Epistemonikos (including treatment, adherence, and outcome terms) identified 67% of the records retrieved by the full search for the overview. A broader search without outcome terms identified 78%, and a very broad search using only treatment terms identified 89%. One key SR (published in 2011) was not indexed in Epistemonikos at the time of our search (March 2019); but was present by April 2019. None of the other records identified solely by the Epistemonikos search were eligible for the overview. The annual number of SRs suggests three distinct periods: a slow rise to the year 2000, a gradual increase in 2000-09, and dramatic growth since, reaching 15,000 to 33,000 in 2018 (41 to 90 per day).

Conclusions More than 40 SRs are now being published daily and stakeholders need to be more aware of Epistemonikos as an aggregating resource. Although the platform might not provide access to all SRs found by a full literature search it would augment such searches and is likely to be adequate in resource-limited situations. If we cannot keep up with SR output when the challenge is four to eight times greater than a decade ago, ways need to be found to focus on high quality SRs that will provide a valid base for EBM, support the increased systematic use of existing evidence and reduce waste.