Researchers conducting systematic reviews need to search multiple bibliographic databases such as MEDLINE and EMBASE. However, researchers have no rational search stopping rule when looking for potentially-relevant articles. We empirically tested a stopping rule based on the concept of capture-mark-recapture (CMR), which was first pioneered in ecology. The principles of CMR can be adapted to systematic reviews and meta-analyses to estimate the Horizon of articles in the literature with its confidence interval. We retrospectively tested this Horizon Estimation using a systematic review of randomized controlled trials (RCTs) that evaluated clinical decision support tools for osteoporosis disease management. The Horizon Estimation was calculated based on 4 bibliographic databases that were included as the main data sources for the review in the following order: MEDLINE, EMBASE, CINAHL, and EBM Reviews. The systematic review captured 68% of known articles from the 4 data sources, which represented 592 articles that were estimated as missing from the Horizon
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