High-performance automated abstract screening with large language model ensembles

TL;DR

This study evaluates the use of large language models for automated abstract screening in systematic reviews, demonstrating they can outperform humans in sensitivity and precision, thus potentially reducing labor costs.

Contribution

The paper introduces a comprehensive evaluation of multiple LLMs for zero-shot abstract screening, highlighting their superior performance and consistency across large datasets.

Findings

LLMs achieved perfect sensitivity in many cases.

LLMs showed higher sensitivity than human reviewers.

Ensembles of LLMs maintained high sensitivity with moderate precision.

Abstract

Large language models (LLMs) excel in tasks requiring processing and interpretation of input text. Abstract screening is a labour-intensive component of systematic review involving repetitive application of inclusion and exclusion criteria on a large volume of studies identified by a literature search. Here, LLMs (GPT-3.5 Turbo, GPT-4 Turbo, GPT-4o, Llama 3 70B, Gemini 1.5 Pro, and Claude Sonnet 3.5) were trialled on systematic reviews in a full issue of the Cochrane Library to evaluate their accuracy in zero-shot binary classification for abstract screening. Trials over a subset of 800 records identified optimal prompting strategies and demonstrated superior performance of LLMs to human researchers in terms of sensitivity (LLM-max = 1.000, human-max = 0.775), precision (LLM-max = 0.927, human-max = 0.911), and balanced accuracy (LLM-max = 0.904, human-max = 0.865). The best performing LLM-prompt combinations were trialled across every replicated search result (n = 119,691), and exhibited consistent sensitivity (range 0.756-1.000) but diminished precision (range 0.004-0.096). 66 LLM-human and LLM-LLM ensembles exhibited perfect sensitivity with a maximal precision of 0.458, with less observed performance drop in larger trials. Significant variation in performance was observed between reviews, highlighting the importance of domain-specific validation before deployment. LLMs may reduce the human labour cost of systematic review with maintained or improved accuracy and sensitivity. Systematic review is the foundation of evidence synthesis across academic disciplines, including evidence-based medicine, and LLMs may increase the efficiency and quality of this mode of research.