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Abstract
Background
There is no consensus on whether screening titles alone or titles and abstracts together is the preferable strategy for inclusion of articles in a systematic review.
Methods
Two methods of screening articles for inclusion in a systematic review were compared: titles first versus titles and abstracts simultaneously. Each citation found in MEDLINE or Embase was reviewed by two physician reviewers for prespecified criteria: the citation included (1) primary data; (2) the exposure of interest; and (3) the outcome of interest.
Results
There were 2965 unique citations. The titles first strategy resulted in an immediate rejection of 2558 (86%) of the records after reading the title alone, requiring review of 239 titles and abstracts, and subsequently 176 full text articles. The simultaneous titles and abstracts review led to rejection of 2782 citations (94%) and review of 183 full text articles. Interreviewer agreement to include an article for full text review using the titles-first screening strategy was 89%–94% (kappa = 0.54) and 96%–97% (kappa = 0.56) for titles and abstracts combined. The final systematic review included 13 articles, all of which were identified by both screening strategies (yield 100%, burden 114%). Precision was higher in the titles and abstracts method (7.1% versus 3.2%) but recall was the same (100% versus 100%), leading to a higher F-measure for the titles and abstracts approach (0.1327 versus 0.0619).
Conclusion
Screening via a titles-first approach may be more efficient than screening titles and abstracts together.
Acknowledgments
The authors thank Dr Kay Dickersin, MA, PhD, at the Center for Clinical Trials, Department of Epidemiology, and Dr Satyanarayana Vedula MBBS, PhD, from the Department of Epidemiology at the Bloomberg School of Public Health, the Johns Hopkins University for their insightful comments, which were integral to the development of an earlier version of this manuscript. Publication of this article was funded in part by the Open Access Promotion Fund of the Johns Hopkins University Libraries. This work is supported by a fellowship grant of the Canadian Institute of Health Research to Dr Farrah Mateen and a Ruth L. Kirschstein NRSA award from the National Institutes of Health to Dr Biren Kamdar (grant # F32 HL104901).
Disclosure
The authors report no conflicts of interest in this work.