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Searching MEDLINE for randomized clinical trials involving care of the newborn
H Kirpalani1, B Schmidt, K A McKibbon
1Department of Pediatrics, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
Insights
Detecting randomized clinical trials (RCTs) for newborn care is challenging. MEDLINE searches offer potential but have limitations in sensitivity and positive predictive value for identifying these crucial pediatric studies.
Area of Science:
- Medical Informatics
- Pediatrics
- Evidence-Based Medicine
Background:
- Randomized clinical trials (RCTs) are a small fraction of medical literature.
- Pediatricians need efficient methods to identify RCTs for newborn care.
- Computerized searches of MEDLINE are a potential tool but require validation.
Purpose of the Study:
- To determine the sensitivity, specificity, and positive predictive value of MEDLINE search strategies for identifying RCTs in newborn care.
- To compare the yield of MEDLINE searches with manual searches.
- To assess the impact of indexing terms on search performance.
Main Methods:
- Two MEDLINE search strategies were developed to find RCTs on newborn disease prevention and treatment.
- Searches covered original articles in ten pediatric and general medical journals from 1985.
- Performance metrics (sensitivity, specificity, PPV) were compared against a manual search.
Main Results:
- Manual search identified 53 RCTs among 2,988 articles.
- MEDLINE searches had sensitivities of 53% and 34%, with positive predictive values of 82% and 69%.
- Specificity was nearly 100%, but 21 RCTs were missed, often due to poor indexing. Removing indexing terms improved sensitivity but reduced PPV.
Conclusions:
- MEDLINE searches can aid in identifying RCTs for newborn care but are imperfect.
- Indexing quality significantly impacts the ability to retrieve relevant RCTs.
- Improved indexing or search strategies are needed to enhance the detection of critical pediatric research.
Abstract:
Randomized clinical trials make up only a small fraction of published articles concerning care of the newborn infant and an even smaller fraction of articles about all human subjects. The busy pediatrician who wants to keep abreast of the medical literature requires strategies to detect such relevant studies promptly and reliably. Computer searching of MEDLINE is an attractive, potentially powerful but not sufficiently validated means of achieving this goal. Therefore, the sensitivity, specificity, and positive predictive value of two MEDLINE search strategies designed to detect randomized clinical trials for prevention and treatment of newborn diseases among all original articles about human subjects appearing in ten pediatric and general medical journals during 1985 were determined. The yield of both MEDLINE searches was compared to that of a manual search. Fifty-three randomized clinical trials of newborn care were identified by hand search among 233 articles concerning care of the newborn and 2,988 original articles about human subjects. The sensitivities of the MEDLINE searches were 53% and 34%, respectively, and the positive predictive values were 82% and 69%, respectively. Specificity of both computer searches was virtually 100%. Twenty-one randomized clinical trials were not identified by either MEDLINE search strategy, 17 of them for failure of the indexer to assign any methodologic terms at all or failure to assign sufficiently stringent methodologic terms. Consequently, sensitivities were higher, 77% and 68% respectively, when no methodologic terms were used during repeat searches. However, positive predictive values decreased concomitantly to 20% or less.(ABSTRACT TRUNCATED AT 250 WORDS)