DISCUSSION
This case study investigated the prospective implementation of different
deprescribing search filters in deprescribing systematic reviews search
strategies. The maximized sensitivity search filters and the USDeN
filter were developed with alternative approaches. USDeN filter was
developed as part of a larger search strategy that include older people
filter and specific drug name deprescribing filter. These alternative
approaches partially explain difference between the filters. The
maximized sensitivity deprescribing filter for MEDLINE included 18
free-text terms, phrases and MeSH terms against 9 free-text terms and
MeSH terms for USDeN’s. Only 3 terms were in common and 2 differs only
by truncation applied. This explained observed differences in
sensitivity and precision.
In both systematic reviews, using the maximized sensitivity search
filters for MEDLINE and Embase either increased or maintained the
strategy’s sensitivity. These results are consistent with the aim of
developing maximized sensitivity filters.
Sensitivity is critical in order for systematic reviews to exhaustively
summarize the evidence7. At equal sensitivity, the
maximized sensitivity search filter was more precise than the original
search strategy in systematic review 2. However, higher sensitivity
(compared to the original search strategy) in systematic review 1 was
associated with lower precision. On the other hand, the USDeN
deprescribing filter had higher precision, thus allowing a significant
decrease in the number needed to read of articles, at the cost of a
lower sensitivity. Precision and number needed to read reflect the
research burden of a search strategy7: the lower the
precision, the higher the number of articles to read to identify one
supplemental relevant article. These performances are crucial for
researchers who have limited resources. From that perspective, the USDeN
deprescribing filter is a valuable tool for scoping reviews or rapid
reviews which are not intended to be systematic.
The main limitation of our case study is the small number of systematic
reviews included. This reduces the extent to which the results can be
generalized. Another limitation is the lack of systematic review
focusing on deprescribing interventions in the included reviews.
To conclude, using maximized sensitivity deprescribing filters may
increase the exhaustivity of deprescribing systematic reviews. On the
other hand, the precision offered by the USDeN deprescribing filter is a
convenient alternative for non-systematic reviews.
Acknowledgments: TM and JPF were involved in the conception of
the study. TM, CH, LZ, EH and AC was involved in data collection; TM and
JPF were involved in data analysis and interpretation. TM drafted the
first version of the manuscript. TM, CH, LZ, EH, AC and JPF read and
approved the final manuscript.
The authors thank Wade Thompson for his precious help in disseminating
the protocol.
Funding: This research did not receive funding.
Reprints and correspondence: Dr Jean-Pascal Fournier,
Département de Médecine Générale, Faculté de Médecine, Université de
Nantes, France. Tel: 33 (0) 24 041 1129, Fax: 33 (0) 24 041 2879,
e-mail:jean-pascal.fournier@univ-nantes.fr
Conflict of interest statement: The authors declare that they
have no competing interest.