Ensembles of Large Language Models for Identifying EQ-5D Studies in PubMed Based on Their Abstracts

Context: Study screening in systematic literature reviews is costly, inconsistency-prone, and risk-asymmetric, since false negatives can compromise validity. Despite rapid uptake of Large Language Models (LLMs), there is limited evidence on how such models behave during the study screening phase, particularly regarding the choice of specific LLMs and their comparison with classical models. Objective: To assess LLM performance and variability in screening, quantify the impact of input metadata (abstract, title, keywords), and compare LLMs with classical classifiers under a shared protocol. Methods: We analyzed 12 LLMs from 4 providers (OpenAI, Google Gemini, Anthropic, Llama) and 4 classical models (Logistic Regression, Support Vector Classification, Random Forest, and Naive Bayes) on 2 real Systematic Literature Reviews (SLRs), totaling 518 papers. The experimental design investigated 3 critical dimensions: (i) LLMs performance variability, (ii) the impact of input feature composition (abstract, title, and keywords) on LLM performance, and (iii) the real gain of using LLMs instead of more traditional classification models. Results: LLMs exhibited substantial heterogeneity and residual non-determinism even at temperature zero. Abstract availability was decisive: removing it consistently degraded performance, while adding title and/or keywords to the abstract yielded no robust gains. Compared to classical models, performance differences were not consistent enough to support generalizable LLM superiority. Discussion: LLM adoption should be justified by operational and governance constraints (reproducibility, cost, metadata availability), supported by pilot validation and explicit reporting of variability and input configuration.

Several studies have examined the use of large language models (LLMs) for title-abstract screening in systematic reviews (SRs), reporting mixed accuracy. However, questions of reliability remain largely unaddressed. In this study, we go beyond quantitative LLM-human agreement metrics and qualitatively investigate how and why LLMs fail. We also propose actionable recommendations. We analyzed disagreements between LLMs and researchers across six software engineering SRs and over 1,000 primary study papers. For each SR, papers were screened independently by human experts and LLMs in zero-shot mode, resulting in Kappa values ranging from 0.52 to 0.77. Qualitative analysis suggests that human-LLM disagreement results from recurring, identifiable causes, such as boundary ambiguity in key terms, keyword overemphasization, and incorrect topic inference. Based on these findings, we propose recommendations such as validating semantic understanding before deployment, running multiple LLMs, and focusing validation efforts on borderline cases. Future studies are needed to validate the impact of our recommendations, and community efforts are needed to develop normative guidelines on LLM usage in SRs.

The rapid growth of scholarly literature has made identifying relevant publications increasingly difficult, and conventional search systems still depend heavily on manually formulated queries and effortful manual inspection. Generative large language models (LLMs) offer a more flexible alternative, supporting literature retrieval and the screening of candidate studies against eligibility criteria. This chapter surveys 34 peer-reviewed papers applying generative LLMs to these two tasks, identified via a Boolean search over the OpenAIRE Graph (1,589 records screened to 34 inclusions). Reviewed studies are characterised by LLMs employed, model access and adaptation, prompting and architectural techniques, ground-truth sources, and evaluation metrics.