Ghada El-Hajj Fuleihan

Fouad Trad, Ryan Yammine, Jana Charafeddine et al.

Systematic reviews (SRs) are essential for evidence-based guidelines but are often limited by the time-consuming nature of literature screening. We propose and evaluate an in-house system based on Large Language Models (LLMs) for automating both title/abstract and full-text screening, addressing a critical gap in the literature. Using a completed SR on Vitamin D and falls (14,439 articles), the LLM-based system employed prompt engineering for title/abstract screening and Retrieval-Augmented Generation (RAG) for full-text screening. The system achieved an article exclusion rate (AER) of 99.5%, specificity of 99.6%, a false negative rate (FNR) of 0%, and a negative predictive value (NPV) of 100%. After screening, only 78 articles required manual review, including all 20 identified by traditional methods, reducing manual screening time by 95.5%. For comparison, Rayyan, a commercial tool for title/abstract screening, achieved an AER of 72.1% and FNR of 5% when including articles Rayyan considered as undecided or likely to include. Lowering Rayyan's inclusion thresholds improved FNR to 0% but increased screening time. By addressing both screening phases, the LLM-based system significantly outperformed Rayyan and traditional methods, reducing total screening time to 25.5 hours while maintaining high accuracy. These findings highlight the transformative potential of LLMs in SR workflows by offering a scalable, efficient, and accurate solution, particularly for the full-text screening phase, which has lacked automation tools.

Fatima Nasser, Fouad Trad, Ammar Mohanna et al.

Systematic reviews require the use of rigorously designed search strategies to ensure both comprehensive retrieval and minimization of bias. Conventional manual approaches, although methodologically systematic, are resource-intensive and susceptible to subjectivity, whereas heuristic and automated techniques frequently under-perform in recall unless supplemented by extensive expert input. We introduce a Large Language Model (LLM)-based chained prompt engineering framework for the automated development of search strategies in systematic reviews. The framework replicates the procedural structure of manual search design while leveraging LLMs to decompose review objectives, extract and formalize PICO elements, generate conceptual representations, expand terminologies, and synthesize Boolean queries. In addition to query construction, the framework exhibits superior performance in generating well-structured PICO elements relative to existing methods, thereby strengthening the foundation for high-recall search strategies. Evaluation on a subset of the LEADSInstruct dataset demonstrates that the framework attains a 0.9 average recall. These results significantly exceed the performance of existing approaches. Error analysis further highlights the critical role of precise objective specification and terminological alignment in optimizing retrieval effectiveness. These findings confirm the capacity of LLM-based pipelines to yield transparent, reproducible, and high-performing search strategies, and highlight their potential as scalable instruments for supporting evidence synthesis and evidence-based practice.