Wilczynski Nancy L, Haynes R Brian
McMaster University, Hamilton, Ontario, Canada.
AMIA Annu Symp Proc. 2003;2003:719-23.
Clinical end users of MEDLINE must be able to retrieve articles that are both scientifically sound and directly relevant to clinical practice. The use of methodologic search filters has been advocated to improve the accuracy of searching for such studies. These filters are available for the literature on therapy and diagnosis, but strategies for the literature on causation have been less well studied.
To determine the retrieval characteristics of methodologic terms in MEDLINE for identifying methodologically sound studies on causation.
Comparison of methodologic search terms and phrases for the retrieval of citations in MEDLINE with a manual hand search of the literature (the gold standard) for 162 core health care journals.
6 trained, experienced research assistants read all issues of 162 journals for the publishing year 2000. Each article was rated using purpose and quality indicators and categorized into clinically relevant original studies, review articles, general papers, or case reports. The original and review articles were then categorized as 'pass' or 'fail' for methodologic rigor in the areas of therapy/quality improvement, diagnosis, prognosis, causation, economics, clinical prediction, and review articles. Search strategies were developed for all categories including causation.
Sensitivity, specificity, precision, and accuracy of the search strategies.
12% of studies classified as causation met basic criteria for scientific merit for testing clinical applications. Combinations of terms reached peak sensitivities of 93%. Compared with the best single term, multiple terms increased sensitivity for sound studies by 15.5% (absolute increase), but with some loss of specificity when sensitivity was maximized. Combining terms to optimize sensitivity and specificity achieved sensitivities and specificities both above 80%.
The retrieval of causation studies cited in MEDLINE can be substantially enhanced by selected combinations of indexing terms and textwords.
医学文献数据库（MEDLINE）的临床终端用户必须能够检索到科学合理且与临床实践直接相关的文章。有人提倡使用方法学检索过滤器来提高此类研究的检索准确性。这些过滤器可用于治疗和诊断方面的文献，但因果关系方面文献的检索策略研究较少。
确定医学文献数据库（MEDLINE）中用于识别因果关系方面方法学合理研究的方法学术语的检索特征。
比较医学文献数据库（MEDLINE）中用于检索引文的方法学检索词和短语与对162种核心医疗保健期刊进行的手工文献检索（金标准）。
6名经过培训且经验丰富的研究助理阅读了2000年出版的162种期刊的所有期。每篇文章根据目的和质量指标进行评分，并分类为临床相关的原始研究、综述文章、一般论文或病例报告。然后，将原始文章和综述文章在治疗/质量改进、诊断、预后、因果关系、经济学、临床预测和综述文章等领域的方法学严谨性分类为“通过”或“未通过”。为包括因果关系在内的所有类别制定了检索策略。
检索策略的敏感性、特异性、精确性和准确性。
被归类为因果关系的研究中有12%符合测试临床应用科学价值的基本标准。术语组合的敏感性峰值达到93%。与最佳单个术语相比，多个术语使合理研究的敏感性提高了15.5%（绝对增加），但在敏感性最大化时特异性有所损失。组合术语以优化敏感性和特异性可使敏感性和特异性均高于80%。
通过索引词和文本词的选定组合，可以大幅提高医学文献数据库（MEDLINE）中引用的因果关系研究的检索效率。
