Each of these designations indicates that participants had been enrolled, that enrollment was no longer taking place, and that there were no plans to reopen enrollment in the future.19 We included trials listed as “active, not recruiting” in our analysis because investigators do not consistently update recruitment status after completing enrollment, and this listing persists indefinitely for many trials. Because of the possibility that publication of these trials was delayed owing to ongoing outcome assessments, we performed a planned subgroup analysis involving trials in which the recruitment status was listed as “completed.” We excluded trial protocols that were withdrawn prior to the beginning of study enrolment; non randomized trials; duplicate registry entries; and studies where the trial registry listed a study completion date after 31 December 2008. This decision was made because it has been shown that in spite of guidelines endorsing prospective trial registration, trials are often not registered for many months after the initiation of participant enrollment.20 In some of these cases, the registration of the trial is performed in preparation for publication and after the decision is made to publish the results.
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