Using large language models to directly screen electronic databases as an alternative to traditional search strategies such as the Cochrane highly sensitive search for filtering randomized controlled trials in systematic reviews.

A critical step in systematic reviews involves the definition of a search strategy, with keywords and Boolean logic, to filter electronic databases. We hypothesize that it is possible to screen articles in electronic databases using large language models (LLMs) as an alternative to search equations. To investigate this matter, we compared two methods to identify randomized controlled trials (RCTs) in electronic databases: filtering databases using the Cochrane highly sensitive search and an assessment by an LLM.We retrieved studies indexed in PubMed with a publication date between September 1 and September 30, 2024 using the sole keyword "diabetes." We compared the performance of the Cochrane highly sensitive search and the assessment of all titles and abstracts extracted directly from the database by GPT-4o-mini to identify RCTs. Reference standard was the manual screening of retrieved articles by two independent reviewers.The search retrieved 6377 records, of which 210 (3.5%) were primary reports of RCTs. The Cochrane highly sensitive search filtered 2197 records and missed one RCT (sensitivity 99.5%, 95% CI 97.4% to100%; specificity 67.8%, 95% CI 66.6% to 68.9%). Assessment of all titles and abstracts from the electronic database by GPT filtered 1080 records and included all 210 primary reports of RCTs (sensitivity 100%, 95% CI 98.3% to100%; specificity 85.9%, 95% CI 85.0% to 86.8%).LLMs can screen all articles in electronic databases to identify RCTs as an alternative to the Cochrane highly sensitive search. This calls for the evaluation of LLMs as an alternative to rigid search strategies.