Machine learning for identifying randomised controlled trials when conducting systematic reviews: Development and evaluation of its impact on practice.

Machine learning (ML) models have been developed to identify randomised controlled trials (RCTs) to accelerate systematic reviews (SRs). However, their use has been limited due to concerns about their performance and practical benefits. We developed a high-recall ensemble learning model using Cochrane RCT data to enhance the identification of RCTs for rapid title and abstract screening in SRs and evaluated the model externally with our annotated RCT datasets. Additionally, we assessed the practical impact in terms of labour time savings and recall improvement under two scenarios: ML-assisted double screening (where ML and one reviewer screened all citations in parallel) and ML-assisted stepwise screening (where ML flagged all potential RCTs, and at least two reviewers subsequently filtered the flagged citations). Our model achieved twice the precision compared to the existing SVM model while maintaining a recall of 0.99 in both internal and external tests. In a practical evaluation with ML-assisted double screening, our model led to significant labour time savings (average 45.4%) and improved recall (average 0.998 compared to 0.919 for a single reviewer). In ML-assisted stepwise screening, the model performed similarly to standard manual screening but with average labour time savings of 74.4%. In conclusion, compared with existing methods, the proposed model can reduce workload while maintaining comparable recall when identifying RCTs during the title and abstract screening stages, thereby accelerating SRs. We propose practical recommendations to effectively apply ML-assisted manual screening when conducting SRs, depending on reviewer availability (ML-assisted double screening) or time constraints (ML-assisted stepwise screening).