example search strategy literature review

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How to write a search strategy for your systematic review

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Practical tips to write a search strategy for your systematic review

With a great review question and a clear set of eligibility criteria already mapped out, it’s now time to plan the search strategy. The medical literature is vast. Your team plans a thorough and methodical search, but you also know that resources and interest in the project are finite. At this stage it might feel like you have a mountain to climb.

The bottom line? You will have to sift through some irrelevant search results to find the studies that you need for your review. Capturing a proportion of irrelevant records in your search is necessary to ensure that it identifies as many relevant records as possible. This is the trade-off of precision versus sensitivity and, because systematic reviews aim to be as comprehensive as possible, it is best to favour sensitivity – more is more.

By now, the size of this task might be sounding alarm bells. The good news is that a range of techniques and web-based tools can help to make searching more efficient and save you time. We’ll look at some of them as we walk through the four main steps of searching for studies:

• Decide where to search
• Write and refine the search
• Run and record the search
• Manage the search results

Searching is a specialist discipline and the information given here is not intended to replace the advice of a skilled professional. Before we look at each of the steps in turn, the most important systematic reviewer pro-tip for searching is:

 Pro Tip – Talk to your librarian and do it early!

1. decide where to search .

It’s important to come up with a comprehensive list of sources to search so that you don’t miss anything potentially relevant. In clinical medicine, your first stop will likely be the databases MEDLINE , Embase , and CENTRAL . Depending on the subject of the review, it might also be appropriate to run the search in databases that cover specific geographical regions or specialist areas, such as traditional Chinese medicine.

In addition to these databases, you’ll also search for grey literature (essentially, research that was not published in journals). That’s because your search of bibliographic databases will not find relevant information if it is part of, for example:

• a trials register
• a study that is ongoing
• a thesis or dissertation
• a conference abstract.

Over-reliance on published data introduces bias in favour of positive results. Studies with positive results are more likely to be submitted to journals, published in journals, and therefore indexed in databases. This is publication bias and systematic reviews seek to minimise its effects by searching for grey literature.

2. Write and refine the search 

Search terms are derived from key concepts in the review question and from the inclusion and exclusion criteria that are specified in the protocol or research plan.

Keywords will be searched for in the title or abstract of the records in the database. They are often truncated (for example, a search for therap* to find therapy, therapies, therapist). They might also use wildcards to allow for spelling variants and plurals (for example, wom#n to find woman and women). The symbols used to perform truncation and wildcard searches vary by database.

Index terms  

Using index terms such as MeSH and Emtree in a search can improve its performance. Indexers with subject area expertise work through databases and tag each record with subject terms from a prespecified controlled vocabulary.

This indexing can save review teams a lot of time that would otherwise be spent sifting through irrelevant records. Using index terms in your search, for example, can help you find the records that are actually about the topic of interest (tagged with the index term) but ignore those that contain only a brief mention of it (not tagged with the index term).

Indexers assign terms based on a careful read of each study, rather than whether or not the study contains certain words. So the index terms enable the retrieval of relevant records that cannot be captured by a simple search for the keyword or phrase.

Use a combination

Relying solely on index terms is not advisable. Doing so could miss a relevant record that for some reason (indexer’s judgment, time lag between a record being listed in a database and being indexed) has not been tagged with an index term that would enable you to retrieve it. Good search strategies include both index terms and keywords.

Let’s see how this works in a real review! Figure 2 shows the search strategy for the review ‘Wheat flour fortification with iron and other micronutrients for reducing anaemia and improving iron status in populations’. This strategy combines index terms and keywords using the Boolean operators AND, OR, and NOT. OR is used first to reach as many records as possible before AND and NOT are used to narrow them down.

• Lines 1 and 2: contain MeSH terms (denoted by the initial capitals and the slash at the end).
• Line 3: contains truncated keywords (‘tw’ in this context is an instruction to search the title and abstract fields of the record).
• Line 4: combines the three previous lines using Boolean OR to broaden the search.
• Line 11: combines previous lines using Boolean AND to narrow the search.
• Lines 12 and 13: further narrow the search using Boolean NOT to exclude records of studies with no human subjects.

Writing a search strategy is an iterative process. A good plan is  to try out a new strategy and check that it has picked up the key studies that you would expect it to find based on your existing knowledge of the topic area. If it hasn’t, you can explore the reasons for this, revise the strategy, check it for errors, and try it again!

3. Run and record the search

Because of the different ways that individual databases are structured and indexed, a separate search strategy is needed for each database. This adds complexity to the search process, and it is important to keep a careful record of each search strategy as you run it. Search strategies can often be saved in the databases themselves, but it is a good idea to keep an offline copy as a back-up; Covidence allows you to store your search strategies online in your review settings.

The reporting of the search will be included in the methods section of your review and should follow the PRISMA guidelines. You can download a flow diagram from PRISMA’s website to help you log the number of records retrieved from the search and the subsequent decisions about the inclusion or exclusion of studies. The PRISMA-S extension provides guidance on reporting literature searches.

It is very important that search strategies are reproduced in their entirety (preferably using copy and paste to avoid typos) as part of the published review so that they can be studied and replicated by other researchers. Search strategies are often made available as an appendix because they are long and might otherwise interrupt the flow of the text in the methods section.

4. Manage the search results 

Once the search is done and you have recorded the process in enough detail to write up a thorough description in the methods section, you will move on to screening the results. This is an exciting stage in any review because it’s the first glimpse of what the search strategies have found. A large volume of results may be daunting but your search is very likely to have captured some irrelevant studies because of its high sensitivity, as we have already seen. Fortunately, it will be possible to exclude many of these irrelevant studies at the screening stage on the basis of the title and abstract alone 😅.

Search results from multiple databases can be collated in a single spreadsheet for screening. To benefit from process efficiencies, time-saving and easy collaboration with your team, you can import search results into a specialist tool such as Covidence. A key benefit of Covidence is that you can track decisions made about the inclusion or exclusion of studies in a simple workflow and resolve conflicting decisions quickly and transparently. Covidence currently supports three formats for file imports of search results:

• EndNote XML
• PubMed text format
• RIS text format

If you’d like to try this feature of Covidence but don’t have any data yet, you can download some ready-made sample data .

And you’re done!

There is a lot to think about when planning a search strategy. With practice, expert help, and the right tools your team can complete the search process with confidence.

This blog post is part of the Covidence series on how to write a systematic review.

Sign up for a free trial of Covidence today!

[1] Witt  KG, Hetrick  SE, Rajaram  G, Hazell  P, Taylor Salisbury  TL, Townsend  E, Hawton  K. Pharmacological interventions for self‐harm in adults . Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD013669. DOI: 10.1002/14651858.CD013669.pub2. Accessed 02 February 2021

Laura Mellor. Portsmouth, UK

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Literature Review: Developing a search strategy

• Traditional or narrative literature reviews
• Scoping Reviews
• Systematic literature reviews
• Annotated bibliography
• Keeping up to date with literature
• Finding a thesis
• Evaluating sources and critical appraisal of literature
• Managing and analysing your literature
• Further reading and resources

From research question to search strategy

Keeping a record of your search activity

Good search practice could involve keeping a search diary or document detailing your search activities (Phelps et. al. 2007, pp. 128-149), so that you can keep track of effective search terms, or to help others to reproduce your steps and get the same results. 

This record could be a document, table or spreadsheet with:

• The names of the sources you search and which provider you accessed them through - eg Medline (Ovid), Web of Science (Thomson Reuters). You should also include any other literature sources you used.
• how you searched (keyword and/or subject headings)
• which search terms you used (which words and phrases)
• any search techniques you employed (truncation, adjacency, etc)
• how you combined your search terms (AND/OR). Check out the Database Help guide for more tips on Boolean Searching.
• The number of search results from each source and each strategy used. This can be the evidence you need to prove a gap in the literature, and confirms the importance of your research question.

A search planner may help you to organise you thoughts prior to conducting your search. If you have any problems with organising your thoughts prior, during and after searching please contact your Library  Faculty Team   for individual help.

• Literature search - a librarian's handout to introduce tools, terms and techniques Created by Elsevier librarian, Katy Kavanagh Web, this document outlines tools, terms and techniques to think about when conducting a literature search.
• Search planner

Literature search cycle

Diagram text description

This diagram illustrates the literature search cycle. It shows a circle in quarters. Top left quarter is identify main concepts with rectangle describing how to do this by identifying:controlled vocabulary terms, synonyms, keywords and spelling. Top right quarter select library resources to search and rectangle describing resources to search library catalogue relevant journal articles and other resource. Bottom right corner of circle search resources and in rectangle consider using boolean searching proximity searching and truncated searching techniques. Bottom left quarter of circle review and refine results. In rectangle evaluate results, rethink keywords and create alerts.

Have a search framework

Search frameworks are mnemonics which can help you focus your research question. They are also useful in helping you to identify the concepts and terms you will use in your literature search.

PICO is a search framework commonly used in the health sciences to focus clinical questions.  As an example, you work in an aged care facility and are interested in whether cranberry juice might help reduce the common occurrence of urinary tract infections.  The PICO framework would look like this:

Now that the issue has been broken up to its elements, it is easier to turn it into an answerable research question: “Does cranberry juice help reduce urinary tract infections in people living in aged care facilities?”

Other frameworks may be helpful, depending on your question and your field of interest. PICO can be adapted to PICOT (which adds T ime) or PICOS (which adds S tudy design), or PICOC (adding C ontext).

For qualitative questions you could use

• SPIDER : S ample,  P henomenon of  I nterest,  D esign,  E valuation,  R esearch type  

For questions about causes or risk,

• PEO : P opulation,  E xposure,  O utcomes

For evaluations of interventions or policies, 

• SPICE: S etting,  P opulation or  P erspective,  I ntervention,  C omparison,  E valuation or
• ECLIPSE: E xpectation,  C lient group,  L ocation,  I mpact,  P rofessionals,  SE rvice 

See the University of Notre Dame Australia’s examples of some of these frameworks. 

You can also try some PICO examples in the National Library of Medicine's PubMed training site: Using PICO to frame clinical questions.

Contact Your Faculty Team Librarian

Faculty librarians are here to provide assistance to students, researchers and academic staff by providing expert searching advice, research and curriculum support.

• Faculty of Arts & Education team
• Faculty of Business, Justice & Behavioural Science team
• Faculty of Science team

Further reading

• << Previous: Annotated bibliography
• Next: Keeping up to date with literature >>
• Last Updated: Apr 10, 2024 5:05 PM
• URL: https://libguides.csu.edu.au/review

Charles Sturt University is an Australian University, TEQSA Provider Identification: PRV12018. CRICOS Provider: 00005F.

Literature Reviews: systematic searching at various levels

• for assignments
• for dissertations / theses
• Search strategy and searching
• Boolean Operators

Search strategy template

• Screening & critiquing
• Citation Searching
• Google Scholar (with Lean Library)
• Resources for literature reviews
• Adding a referencing style to EndNote
• Exporting from different databases
• PRISMA Flow Diagram
• Grey Literature

You can map out your search strategy in whatever way works for you.

Some people like lists and so plan their search strategy out in a grid-box or table format. Some people are more visual and like to draw their strategy out using a mind-map approach (either on paper or using mind-mapping software). Some people use sticky notes or Trello or a spreadsheet.

If it works for you then as long as it enables you to search systematically and thoroughly there's no need to change the way you work. 

If your search strategies are not very developed, the method you use doesn't lead to a good search, then consider using one of the other methods to see if changing your approach helps.

• Search Strategy Document
• << Previous: Boolean Operators
• Next: Screening & critiquing >>
• Last Updated: Apr 12, 2024 11:57 AM
• URL: https://libguides.derby.ac.uk/literature-reviews

Trinity College Dublin, The University of Dublin

Trinity Search

Trinity menu.

• Faculties and Schools
• Trinity Courses
• Trinity Research

Writing a Literature Review

• Getting Started
• Defining the Scope
• Finding the Literature

Getting your search right

Keyword searches, widening your search: truncation and wildcards, combining your terms: search operators, being more specific: phrase and proximity searching, subject headings, combining keyword and subject heading searches, using methodological search filters.

• Managing Your Research
• Writing the Review
• Systematic Reviews and Other Review Types
• Useful Books
• Useful Videos
• Useful Links
• Commonly Used Terms

Test your strategy!

• Search the database for each of the test records and make a note of the unique record number for each one - in Medline this is in the UI field.
• Run your search strategy.
• Run a search for all the record numbers for your test set using 'OR' in between each one.
• Lastly combine the result of your search strategy with the test set using 'OR'.
• If the number of records retrieved stays the same then the strategy has identified all the records. If it doesn't, combine the result of your search strategy with the test set, this time using 'NOT'. This will identify the records in your test set which are not being retrieved. Work out why these weren't retrieved and adjust your search strategy accordingly.

Think about...

• abbreviations
• related terms
• UK/US spellings
• singular/plural forms of words
• thesaurus terms (where available)

Your search is likely to be complex and involve multiple steps to do with different subjects, what are often called "strands" or "strings" in the search. Look at the appendices of existing reviews for an idea of what's involved in creating a comprehensive search.

Most people should start by finding all the articles on Topic A, then moving on to Topic B, then Topic C (and so on), then combining those strands together using AND (see Combining your terms: search operators below). This will then give you results that mention all those topics.

You will then need to adapt (or "translate") your strategy for each database depending on the searching options available on each one. A core of terms is used across multiple databases - this is the "systematic" part - BUT with additions and subtractions as necessary. While the words in the title and abstract might remain the same, it's highly likely the thesaurus terms (if they exist) will be different across the databases. You may need to leave out some strings completely; for example, let's say you are doing a study that needs to find Randomised Controlled Trials (RCTs) on a particular disease and its treatment. You will be looking in multiple databases for words to do with the condition, and also words that are used for RCTs. But when you are looking in databases that are composed entirely of RCTs (trials registers), the part of a search looking for RCTs doesn’t need to be included as it's redundant.

The techniques described below will help ensure you cover everything. Contact your Subject Librarian if you would like guidance on constructing your search.

This video from the University of Reading gives a good overview of literature searching tips and tricks:

Jump to 01:45 for truncation and 05:46 for wildcards.

• Contact your Subject Librarian
• How to translate searches between certain databases A fantastic crib sheet from Karolinska Institutet University Library, showing how to translate searches between Medline (Ovid), PsycInfo (Ovid), Embase (Elsevier), Web of Science, Cinahl (Ebsco), Cochrane (Wiley), and PubMed.

Most searches have two elements - the "keywords" part and the "subject headings" part - for each topic. When you are initially constructing your search and trialling it in a database, you are likely to just add your keywords, click Search, and see how many that retrieves. But after that, for any type of comprehensive search, you should look at limiting your keywords to looking in specific search fields .

A field in this context is where the database only looks at one aspect of the information about the article. Common examples are the Author, Title, Abstract, and Journal Name. More esoteric ones could be fields like the CAS Registry Entry or Corporate Author.

In complex reviews like systematic, scoping and rapid reviews, the accepted wisdom is to limit these "keyword" searches to the Title and Abstract fields, plus (if available, and the search is looking to be comprehensive) any available "Author Keyword" or "Contributed Indexing" fields. It is vital that the keywords you use in these fields are identical - you are using the same words in the Title, Abstract and any related fields - and that you combine them using OR (see Combining your terms: search operators below)

Using keyword searching limited to the Title/Abstract/Keywords fields should reduce the number of results which are retrieved in error or are only on the periphery of your subject. If you do this, please be aware that you will need to ensure that you have definitely also included all relevant subject headings in your search strategy (in databases that use controlled vocabulary) otherwise you risk missing out on useful results. It *is* quite possible that there will be no relevant subject headings in a particular search.

Although some databases will automatically search for variant spellings, mostly they will just search for the exact letters you type in. Use wildcard and truncation symbols to take control of your search and include variations to widen your search and ensure you don't miss something relevant.

A truncation symbol (*) retrieves any number of letters  - useful to find different word endings based on the root of a word: africa*  will find africa, african, africans, africaans agricultur*  will find agriculture, agricultural, agriculturalist

A wildcard symbol (?) replaces a single letter . It's useful for retrieving alternate spelling spellings (i.e. British vs American English) and simple plurals: wom?n  will find woman or women behavio?r  will find behaviour or behavior

Hint: Not all databases use the * and ? symbols - some may use different ones (! instead of *, for example), or not have the feature at all, so check the online help section of the database before you start.

• Introduction

Search operators (also called Boolean operators) allow you to include multiple words and concepts in your searches. This means you can search for all of your terms at once rather than carrying out multiple searches for each concept.

There are three main operators:

• OR - for combining alternative words for your concepts and widening your results e.g. women OR gender
• AND - for combining your concepts giving more specific results e.g. women AND Africa
• NOT  - to exclude specific terms from your search - use this with caution as you might exclude relevant results accidentally!

women OR female

Using OR will bring you back records containing either of your search terms. It will return items that include both terms, but will also return items that contain only one of the terms.

This will give you a broader range of results.

OR can be used to link together synonyms. These are then placed in brackets to show that they are all the same concept.

• (cat OR kitten OR feline)
• (women OR female)

women AND Africa

Using AND will find items that contain both of your search terms, giving you a more specific set of results.

If you're getting too many results, using AND can be a good way to narrow your search.

women NOT Africa

Using NOT will find articles containing a particular term, but will exclude articles containing your second term.

Use this with caution - by excluding results you might miss out on key resources.

• Phrase searching
• Proximity searching

Sometimes your search may contain common words (i.e. development, communication) which will retrieve too many irrelevant records, even when using an AND search. On many databases, including Google, to look for a specific phrase, use inverted commas:

• "agricultural development"
• "foot and mouth"

Your search will only bring back items containing these exact phrases.

Some databases automatically perform a phrase search if you do not use any search operators. For example, "agriculture africa" is not a phrase used in English so you may not find any items on the subject. Use AND in between your search words to avoid this.

On Scopus to search for an exact phrase use { } e.g. {agricultural development}. Using quotes on Scopus will find your words in the same field (e.g., title) but not necessarily next to one another. In this database, you need to be very careful with those brackets - {heart-attack} and {heart attack} will return different results because the dash is included. Wildcards are searched as actual characters, e.g. {health care?} returns results such as: Who pays for health care?

Some databases use proximity operators, which are a more advanced search function. You can use these to tell the database how close one word must be to another and, in some cases, in what order. This makes a search more specific and excludes irrelevant records.

For instance, if you were searching for references about women in Africa, you might retrieve irrelevant records for items about women published in Africa. Performing a proximity search will only retrieve the two words in the same sentence, making your search more accurate.

Each database has its own way of proximity searching, often with multiple ways of doing it, so it's important to check the online help before you start . Here are some examples of the variety of possible searches:

• Web of Science : women  same Africa - retrieves records where the words 'women' and 'Africa' appear in the same sentence
• JSTOR : agricultural development ~5  - retrieves records where the words 'agricultural' and 'development' are within five words of one another
• Scopus : agricultural  W/2 development - retrieves records where the word 'agricultural' is within two words of the word 'development'. 

After completing your keywords search on a topic, you can move on to looking for appropriate subject headings.

Most databases have this controlled vocabulary feature (standardised subject headings or thesaurus terms - a bit like standard tags) which can help ensure you capture all the relevant studies; for example, MEDLINE, CENTRAL and PubMed use the exact same headings, which are called MeSH (Medical Subject Headings). Some of these headings will be the same in other related databases like CINAHL, but many of them will be slightly different, could be the same but have subtly different meanings, or not be there at all.

Not all databases have these types of subject headings - Web of Science and JSTOR don't allow you to search for subject headings like these, although you can of course search for subjects in them.

The easiest way to search for a subject heading is to go to the relevant area in the database that searches specifically for them; this might be called something like Thesaurus, Subject Headings, or similar. Then search for some of the words to do with your topic - not all of them at once, just a word on its own or a very simple phrase. Does this bring anything up? When you read the description, are you talking about the same thing?

You can then tell it to search for everything listed under that subject heading, then move on to looking for another subject heading. It's quite common for one topic to have several relevant headings.

Once you have found all the relevant headings, and made the database run searches for them, you will then combine them together using OR.

After you have found all the title/abstract/keywords for Topic A, and then all the relevant subject headings, you then combine those together using OR. You may need to go into the Search History section of the database to do this, and work out whether you can tick boxes next to your various searches to combine them, or have to type out something like "#1 OR #2".

This gives you a "super search" with everything in the database on that topic. It's likely to be a lot!

It might be that adding them together gives no extra results than the amount in either the keywords or the subject headings on their own. This is unusual, but not impossible:

You now go back to the start and for Topic B do the same title/abstract/keywords searches, then the relevant subject headings searches, then combine them as above. Then Topic C, and so on. Again, each of these super searches may have very high numbers - possibly millions.

Finally, you then combine all these super searches together, but this time using AND; they need to mention all the topics. It's possible that there are no articles in that database that mention all those things - the more subjects you AND together, the less results you are likely to find. However, it's also possible to end up with zero as there is a mistake in your search, and in most cases having zero results won't allow you to write your paper or thesis. So contact us if you think you have too few or two many results, and we can advise.

Methodological search filters are search terms or strategies that identify a topic or aspect. They are predefined, tried and tested filters which can be applied to a search.

Study types: 'systematic reviews', 'Randomised Controlled Trials'

Age groups: 'children', 'elderly'

Language: 'English'

They are available to select via the results filters displayed alongside your results and are normally applied at the very end of your search . For instance, on PubMed after running your results it is possible to limit by 'Ages' which gives predefined groupings such as 'Infant: birth-23 months'. These limits and filters are not always the same across the databases, so do be careful .

• << Previous: Finding the Literature
• Next: Managing Your Research >>
• Last Updated: Oct 10, 2023 1:52 PM
• URL: https://libguides.tcd.ie/literature-reviews

Making Literature Reviews Work: A Multidisciplinary Guide to Systematic Approaches pp 145–200 Cite as

Search Strategies for [Systematic] Literature Reviews

• Rob Dekkers 4 ,
• Lindsey Carey 5 &
• Peter Langhorne 6  
• First Online: 11 August 2022

1927 Accesses

3 Citations

After setting review questions as discussed in the previous chapter, the search for relevant publications is the next step of a literature review.

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JEL is the abbreviation of the ‘Journal of Economics Literature’, published by the American Economic Association, which launched this coding system.

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The wording ‘topical bibliography’ by Schlosser et al. ( 2006 , p. 574) has been replaced with ‘topical survey’ in order to connect better to the terminology in this book.

Webster and Watson ( 2002 , p. xvi) call it forward searching and backward searching rather than snowballing. See Table 5.3 for the nomenclature used in the book for search strategies.

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Dekkers, R., Carey, L., Langhorne, P. (2022). Search Strategies for [Systematic] Literature Reviews. In: Making Literature Reviews Work: A Multidisciplinary Guide to Systematic Approaches. Springer, Cham. https://doi.org/10.1007/978-3-030-90025-0_5

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Systematic Reviews

• Search Strategy
• Work with a Search Expert
• Covidence Review Software
• Types of Reviews
• Evidence in a Systematic Review
• Information Sources

Developing an Answerable Question

Creating a search strategy, identifying synonyms & related terms, keywords vs. index terms, combining search terms using boolean operators, a sr search strategy, search limits.

• Managing Records
• Selection Process
• Data Collection Process
• Study Risk of Bias Assessment
• Reporting Results
• For Search Professionals

Validated Search Filters

Depending on your topic, you may be able to save time in constructing your search by using specific search filters (also called "hedges") developed & validated by researchers in the Health Information Research Unit (HiRU) of McMaster University, under contract from the National Library of Medicine.  These filters can be found on

• PubMed’s Clinical Queries &  Health Services Research Queries pages
• Ovid Medline’s Clinical Queries  filters or here
• Embase  & PsycINFO
• EBSCOhost’s main search page for CINAHL (Clinical Queries category)
• HiRU’s Nephrology Filters page
• American U of Beirut, esp. for " humans" filters .
• Countway Library of Medicine methodology filters
• InterTASC Information Specialists' Sub-Group Search Filter Resource
• SIGN (Scottish Intercollegiate Guidelines Network) filters page

Why Create a Sensitive Search?

In many literature reviews, you try to balance the sensitivity of the search (how many potentially relevant articles you find) &  specificit y (how many definitely relevant articles  you find ), realizing that you will miss some.  In a systematic review, you want a very sensitive search:  you are trying to find any potentially relevant article.  A systematic review search will:

• contain many synonyms & variants of search terms
• use care in adding search filters
• search multiple resources, databases & grey literature, such as reports & clinical trials

PICO is a good framework to help clarify your systematic review question.

P -   Patient, Population or Problem: What are the important characteristics of the patients &/or problem?

I -  Intervention:  What you plan to do for the patient or problem?

C -  Comparison: What, if anything, is the alternative to the intervention?

O -  Outcome:  What is the outcome that you would like to measure?

Beyond PICO: the SPIDER tool for qualitative evidence synthesis.

5-SPICE: the application of an original framework for community health worker program design, quality improvement and research agenda setting.

A well constructed search strategy is the core of your systematic review and will be reported on in the methods section of your paper. The search strategy retrieves the majority of the studies you will assess for eligibility & inclusion. The quality of the search strategy also affects what items may have been missed.  Informationists can be partners in this process.

For a systematic review, it is important to broaden your search to maximize the retrieval of relevant results.

Use keywords:  How other people might describe a topic?

Identify the appropriate index terms (subject headings) for your topic.

• Index terms differ by database (MeSH, or  Medical Subject Headings ,   Emtree terms , Subject headings) are assigned by experts based on the article's content.
• Check the indexing of sentinel articles (3-6 articles that are fundamental to your topic).  Sentinel articles can also be used to  test your search results.

Include spelling variations (e.g., behavior, behaviour ).  

Both types of  search terms are useful & both should be used in your search.

Keywords help to broaden your results.  They will be searched for at least in journal titles, author names, article titles, & article abstracts.  They can also be tagged to search all text.

Index/subject terms  help to focus your search appropriately, looking for items that have had a specific term applied by an indexer.

Boolean operators let you combine search terms in specific ways to broaden or narrow your results.

An example of a search string for one concept in a systematic review.

In this example from a PubMed search, [mh] = MeSH &  [tiab] = Title/Abstract, a more focused version of a keyword search.

A typical database search limit allows you to narrow results so that you retrieve articles that are most relevant to your research question. Limit types vary by database & include:

• Article/publication type
• Publication dates

In a systematic review search, you should use care when applying limits, as you may lose articles inadvertently.  For more information, see, particularly regarding language & format limits.     Cochrane 2008 6.4.9

• Subject guides
• Researching for your literature review
• Develop a search strategy

Researching for your literature review: Develop a search strategy

• Literature reviews
• Literature sources
• Before you start
• Keyword search activity
• Subject search activity
• Combined keyword and subject searching
• Online tutorials
• Apply search limits
• Run a search in different databases
• Supplementary searching
• Save your searches
• Manage results

Identify key terms and concepts

Start developing a search strategy by identifying the key words and concepts within your research question. The aim is to identify the words likely to have been used in the published literature on this topic.

For example: What are the key infection control strategies for preventing the transmission of Meticillin-resistant Staphylococcus aureus (MRSA) in aged care homes .

Treat each component as a separate concept so that your topic is organised into separate blocks (concepts).

For each concept block, list the key words derived from your research question, as well as any other relevant terms or synonyms that you have found in your preliminary searches. Also consider singular and plural forms of words, variant spellings, acronyms and relevant index terms (subject headings).  

As part of the process of developing a search strategy, it is recommended that you keep a master list of search terms for each key concept. This will make it easier when it comes to translating your search strategy across multiple database platforms. 

Concept map template for documenting search terms

Combine search terms and concepts

Boolean operators are used to combine the different concepts in your topic to form a search strategy. The main operators used to connect your terms are AND and OR . See an explanation below:

• Link keywords related to a single concept with OR
• Linking with OR broadens a search (increases the number of results) by searching for any of the alternative keywords

Example: nursing home OR aged care home

• Link different concepts with AND
• Linking with AND narrows a search (reduces the number of results) by retrieving only those records that include all of your specified keywords

Example: nursing home AND infection control

• using NOT narrows a search by excluding results that contain certain search terms
• Most searches do not require the use of the NOT operator

Example: aged care homes NOT residential homes will retrieve all the results that include the words aged care homes but don't include the words residential homes . So if an article discussed both concepts this article would not be retrieved as it would be excluded on the basis of the words residential homes .

See the website for venn diagrams demonstrating the function of AND/OR/NOT:

Combine the search terms using Boolean

Advanced search operators - truncation and wildcards

By using a truncation symbol you can capture all of the various endings possible for a particular word. This may increase the number of results and reduce the likelihood of missing something relevant. Some tips about truncation:

• The truncation symbol is generally an asterisk symbol * and is added at the end of a word.
• It may be added to the root of a word that is a word in itself. Example: prevent * will retrieve prevent, prevent ing , prevent ion prevent ative etc. It may also be added to the root of a word that is not a word in itself. Example: strateg * will retrieve strateg y , strateg ies , strateg ic , strateg ize etc.
• If you don't want to retrieve all possible variations, an easy alternative is to utilise the OR operator instead e.g. strategy OR strategies. Always use OR instead of truncation where the root word is too small e.g. ill OR illness instead of ill*

There are also wildcard symbols that function like truncation but are often used in the middle of a word to replace zero, one or more characters.

• Unlike the truncator which is usually an asterisk, wildcards vary across database platforms
• Common wildcards symbols are the question mark ? and hash #.
• Example:  wom # n finds woman or women, p ? ediatric finds pediatric or paediatric.  

See the Database search tips for details of these operators, or check the Help link in any database.

Phrase searching

For words that you want to keep as a phrase, place two or more words in "inverted commas" or "quote marks". This will ensure word order is maintained and that you only retrieve results that have those words appearing together.

Example: “nursing homes”

There are a few databases that don't require the use of quote marks such as Ovid Medline and other databases in the Ovid suite. The Database search tips provides details on phrase searching in key databases, or you can check the Help link in any database.

Subject headings (index terms)

Identify appropriate subject headings (index terms).

Many databases use subject headings to index content. These are selected from a controlled list and describe what the article is about. 

A comprehensive search strategy is often best achieved by using a combination of keywords and subject headings where possible.

In-depth knowledge of subject headings is not required for users to benefit from improved search performance using them in their searches.

Advantages of subject searching:

• Helps locate articles that use synonyms, variant spellings, plurals
• Search terms don’t have to appear in the title or abstract

Note: Subject headings are often unique to a particular database, so you will need to look for appropriate subject headings in each database you intend to use.

Subject headings are not available for every topic, and it is best to only select them if they relate closely to your area of interest.

MeSH (Medical Subject Headings)

The MeSH thesaurus provides standard terminology, imposing uniformity and consistency on the indexing of biomedical literature. In Pubmed/Medline each record is tagged with  MeSH  (Medical Subject Headings).

The MeSH vocabulary includes:

• Represent concepts found in the biomedical literature
• Some headings are commonly considered for every article (eg. Species (including humans), Sex, Age groups (for humans), Historical time periods)
• attached to MeSH headings to describe a specific aspect of a concept
• describe the type of publication being indexed; i.e., what the item is, not what the article is about (eg. Letter, Review, Randomized Controlled Trial)
• Terms in a separate thesaurus, primarily substance terms

Create a 'gold set'

It is useful to build a ‘sample set’ or ‘gold set’ of relevant references before you develop your search strategy..

Sources for a 'gold set' may include:

• key papers recommended by subject experts or supervisors
• citation searching - looking at a reference list to see who has been cited, or using a citation database (eg. Scopus, Web of Science) to see who has cited a known relevant article
• results of preliminary scoping searches.

The papers in your 'gold set' can then be used to help you identify relevant search terms

• Look up your 'gold set' articles in a database that you will use for your literature review. For the articles indexed in the database, look at the records to see what keywords and/or subject headings are listed.

The 'gold set' will also provide a means of testing your search strategy

• When an article in the sample set that is also indexed in the database is not retrieved, your search strategy can be revised in order to include it (see what concepts or keywords can be incorporated into your search strategy so that the article is retrieved).
• If your search strategy is retrieving a lot of irrelevant results, look at the irrelevant records to determine why they are being retrieved. What keywords or subject headings are causing them to appear? Can you change these without losing any relevant articles from your results?
• Information on the process of testing your search strategy using a gold set can be found in the systematic review guide

Example search strategy

A search strategy is the planned and structured organisation of terms used to search a database.

An example of a search strategy incorporating all three concepts, that could be applied to different databases is shown below:

You will use a combination of search operators to construct a search strategy, so it’s important to keep your concepts grouped together correctly. This can be done with parentheses (round brackets), or by searching for each concept separately or on a separate line.

The above search strategy in a nested format (combined into a single line using parentheses) would look like:

("infection control*" OR "infection prevention") AND ("methicillin resistant staphylococcus aureus" OR "meticillin resistant staphylococcus aureus" OR MRSA) AND ( "aged care home*" OR "nursing home*")

• << Previous: Search strategies - Health/Medical topic example
• Next: Keyword search activity >>

Conducting a Literature Review

• Literature Review
• Developing a Topic
• Planning Your Literature Review

Developing a Search Strategy

• Managing Citations
• Critical Appraisal Tools
• Writing a Literature Review

A search strategy is an organized structure of key terms used to search a database. The search strategy combines the key concepts of your search question in order to retrieve accurate results.

Your search strategy will account for all:

• possible search terms
• keywords and phrases
• truncated and wildcard variations of search terms
• subject headings (where applicable)

Each database works differently so you need to adapt your search strategy for each database. You may wish to develop a number of separate search strategies if your research covers several different areas. 

It is a good idea to test your strategies and refine them after you have reviewed the search results.

This is a sample planner to develop your search terms from a PICO format

Identifying Search Terms

Once you have developed your research question or chosen your topic you can begin to brainstorm terms to use in your database search.

• Brainstorm terms authors or indexers might use to describe your topic
• Make a list of terminology and relevant terms to use in your search
• Include synonyms or similar terms to combine using the Boolean operator OR
• Search for controlled vocabulary in the databases i.e. search PubMed for MeSH terms

Combine the Elements of Your PICO Question with Boolean Operators

Boolean Operators (Using AND, OR NOT):

Boolean logic is a building block of many computer applications and is an important concept in database searching.  Using the correct Boolean operator can make all the difference in a successful search.

AND, OR, NOT

There are three basic Boolean search commands:  AND ,  OR  and  NOT .

• AND  searches find all of the search terms.  For example, searching on dengue  AND  malaria  AND  zika  returns only results that contain all three search terms.  Very limited results.
• OR  searches find one term or the other.  Searching on dengue  OR  malaria  OR  zika returns all items that contain any of the three search terms.  Returns a large number of results.
• NOT  eliminates items that contain the specified term.  Searching on malaria  NOT  zika returns items that are about malaria, but will specifically  NOT  return items that contain the word zika.  This is a way to fine-tune results. Note:  sometimes  AND NOT  is used; serves the same function as  NOT

Using Boolean Search with Exact Phrases:

If you're searching for a phrase rather than just a single word, you can group the words together with quotation marks.  Searching on "dengue fever" will return only items with that exact phrase.  

When to use Parentheses?

Think of your search in concepts, then put those concepts inside parentheses.  Different databases have different rules about combining searches.  To make sure you get the search you want, use parentheses - every database follows those rules.

Run a Preliminary Search

Look at titles and publication dates to decide which articles you want to look at in depth.

• Select an article and begin the skimming and scanning process.
• If the list has too many irrelevant results, consider selecting different keywords and revising your search.
• If the list has too many results, consider setting date limiters or narrowing your results by searching phrases instead of keywords.
• If the list has too few results, consider selecting different keywords

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A Guide to Evidence Synthesis: 4. Write a Search Strategy

• Meet Our Team
• Our Published Reviews and Protocols
• What is Evidence Synthesis?
• Types of Evidence Synthesis
• Evidence Synthesis Across Disciplines
• Finding and Appraising Existing Systematic Reviews
• 0. Develop a Protocol
• 1. Draft your Research Question
• 2. Select Databases
• 3. Select Grey Literature Sources
• 4. Write a Search Strategy
• 5. Register a Protocol
• 6. Translate Search Strategies
• 7. Citation Management
• 8. Article Screening
• 9. Risk of Bias Assessment
• 10. Data Extraction
• 11. Synthesize, Map, or Describe the Results
• Evidence Synthesis Institute for Librarians
• Open Access Evidence Synthesis Resources

Video: Databases and search strategies (3:40 minutes)

Writing a Search Strategy

It is recommended that you work with a librarian to help you design comprehensive search strategies across a variety of databases. Writing a successful search strategy takes an intimate knowledge of bibliographic databases.  

Using Boolean logic is an important component of writing a search strategy: 

• "AND" narrows the search, e.g.  children AND exercise
• "OR" broadens the search, e.g.  (children OR adolescents) AND (exercise OR diet) 
• "NOT" excludes terms, e.g.  exercise NOT diet 
• "*" at the root of a word finds all forms of that word, e.g.  (child* OR adolescen*) AND (exercise* OR diet*)
• parentheses ensure all terms will be searched together as a set 
• quotations around a phrase searches that exact phrase, e.g.  (child* OR adolescen* OR "young adult*") 

Evidence Synthesis Search Strategy Examples

Agriculture example: .

• Research question:  What are the strategies that farmer organizations use, and what impacts do those strategies have on small-scale producers in Sub Saharan Africa and India? 
• Key concepts from the question combined with AND:  (farmer organizations) AND (Sub-Saharan Africa OR India) 
• Protocol and search strategies for this question in CAB Abstracts, Scopus, EconLit, and grey literature
• Published scoping review for this question

Nutrition Example: 

• Research question:  What are the health benefits and safety of folic acid fortification of wheat and maize flour (i.e. alone or in combination with other micronutrients) on folate status and health outcomes in the overall population, compared to wheat or maize flour without folic acid (or no intervention)? 
• Key concepts from the question combined with AND:  (folic acid) AND (fortification) 
• Protocol on PROSPERO
• Published systematic review for this question with search strategies used in 14 databases

Search Strategy Template and Filters

• Human Studies Filter
• Randomized Controlled Trial Filters
• Other Methodology Search Filters

If you want to exclude animal studies from your search results, you may add a "human studies filter" to the end of your search strategy. This approach works best with databases that use Medical Subject Headings (MeSH) or other controlled vocabulary. You can see an example of how this was used in the MEDLINE(Ovid) search strategy of this published review (lines 13-14).

A simplified explanation of this filter can be seen below:

Add the following lines to the end of your search strategy to filter for randomized controlled trials. These are "validated search filters" meaning they have been tested for sensitivity and specificity, and the results of those tests have been published as a scientific article. The ISSG Search Filters Resource provides validated search filters for many other study design types. 

Highly Sensitive MEDLINE (via PubMed) Filter from Cochrane  

(randomized controlled trial [pt] OR controlled clinical trial [pt] OR randomized [tiab] OR placebo [tiab] OR drug therapy [sh] OR randomly [tiab] OR trial [tiab] OR groups [tiab])

Highly Sensitive MEDLINE (OVID) Filter from Cochrane 

((randomized controlled trial.pt. or controlled clinical trial.pt. or randomized.ab. or placebo.ab. or drug therapy.fs. or randomly.ab. or trial.ab. or groups.ab.) not (exp animals/ not humans.sh.)) ​

CINAHL Filter from Cochrane 

TX allocat* random* OR (MH "Quantitative Studies") OR (MH "Placebos") OR TX placebo* OR TX random* allocat* OR (MH "Random Assignment") OR TX randomi* control* trial* OR TX ( (singl* n1 blind*) OR (singl* n1 mask*) ) OR TX ( (doubl* n1 blind*) OR (doubl* n1 mask*) ) OR TX ( (tripl* n1 blind*) OR (tripl* n1 mask*) ) OR TX ( (trebl* n1 blind*) OR (trebl* n1 mask*) ) OR TX clinic* n1 trial* OR PT Clinical trial OR (MH "Clinical Trials+")

PsycINFO Filter from ProQuest:

SU.EXACT("Treatment Effectiveness Evaluation") OR SU.EXACT.EXPLODE("Treatment Outcomes") OR SU.EXACT("Placebo") OR SU.EXACT("Followup Studies") OR placebo* OR random* OR "comparative stud*" OR  clinical NEAR/3 trial* OR research NEAR/3 design OR evaluat* NEAR/3 stud* OR prospectiv* NEAR/3 stud* OR (singl* OR doubl* OR trebl* OR tripl*) NEAR/3 (blind* OR mask*)

Web Of Science (WoS) Filter from University of Alberta - Not Validated

TS= clinical trial* OR TS=research design OR TS=comparative stud* OR TS=evaluation stud* OR TS=controlled trial* OR TS=follow-up stud* OR TS=prospective stud* OR TS=random* OR TS=placebo* OR TS=(single blind*) OR TS=(double blind*)

Scopus Filter from Children's Mercy Kansas City

TITLE-ABS-KEY((clinic* w/1 trial*) OR (randomi* w/1 control*) OR (randomi* w/2 trial*) OR (random* w/1 assign*) OR (random* w/1 allocat*) OR (control* w/1 clinic*) OR (control* w/1 trial) OR placebo* OR (Quantitat* w/1 Stud*) OR (control* w/1 stud*) OR (randomi* w/1 stud*) OR (singl* w/1 blind*) or (singl* w/1 mask*) OR (doubl* w/1 blind*) OR (doubl* w/1 mask*) OR (tripl* w/1 blind*) OR (tripl* w/1 mask*) OR (trebl* w/1 blind*) OR (trebl* w/1 mask*)) AND NOT (SRCTYPE(b) OR SRCTYPE(k) OR SRCTYPE(p) OR SRCTYPE(r) OR SRCTYPE(d) OR DOCTYPE(ab) OR DOCTYPE(bk) OR DOCTYPE(ch) OR DOCTYPE(bz) OR DOCTYPE(cr) OR DOCTYPE(ed) OR DOCTYPE(er) OR DOCTYPE(le) OR DOCTYPE(no) OR DOCTYPE(pr) OR DOCTYPE(rp) OR DOCTYPE(re) OR DOCTYPE(sh))

Sources and more information:

• Cochrane Handbook for Systematic Reviews of Interventions
• Cochrane RCT Filters for Different Databases
• American University of Beirut University Libraries Search Filters / Hedges
• Methodology Search Filters by Study Design - Countway Library of Medicine, Harvard University Filters for RCTs, CCTs, Non-randomized/observational designs, and tests of diagnostic accuracy.
• Search Filters - American University of Beirut University Libraries Filters for RCTs, GUIDELINEs, systematic reviews, qualitative studies, etc.

Pre-generated queries in Scopus for the UN Sustainable Development Goals

Pre-written SDG search strategies available in Scopus 

Scopus, a multidisciplinary research database, provides pre-written search strategies to capture articles on topics about each of the 17 United Nations Sustainable Development Goals  (SDGs). These search strategies were updated in 2023 and are no longer available directly on "Advanced Document Search". To use these SDG search strategies:

• Go to the Elsevier 2023 Sustainable Development Goals (SDGs) Mapping page.
• Under Files , click on the SDG 2023 Queries folder.
• Download the .txt file for each pre-written search strategy you are interested in. You will need to know the number of the SDG of interest (e.g., SDG01.txt is for SDG 1: No Poverty). This .txt file will contain the entire search string for the SDG, already written in Scopus syntax .
• In Scopus , click on "Advanced Document Search".
• Copy and paste the pre-written SDG search strategy into the search field.

More about the Sustainable Development Goals: 

" The 2030 Agenda for Sustainable Development,  adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. At its heart are the 17 Sustainable Development Goals (SDGs), which are an urgent call for action by all countries - developed and developing - in a global partnership. They recognize that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests."

Source:  https://sdgs.un.org/goals 

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• Next: 5. Register a Protocol >>
• Last Updated: Apr 22, 2024 2:24 PM
• URL: https://guides.library.cornell.edu/evidence-synthesis

• UNC Libraries
• HSL Academic Process
• Systematic Reviews
• Step 3: Conduct Literature Searches

Systematic Reviews: Step 3: Conduct Literature Searches

Created by health science librarians.

• Step 1: Complete Pre-Review Tasks
• Step 2: Develop a Protocol

About Step 3: Conduct Literature Searches

Partner with a librarian, systematic searching process, choose a few databases, search with controlled vocabulary and keywords, acknowledge outdated or offensive terminology, helpful tip - building your search, use nesting, boolean operators, and field tags, build your search, translate to other databases and other searching methods, document the search, updating your review.

• Searching FAQs
• Step 4: Manage Citations
• Step 5: Screen Citations
• Step 6: Assess Quality of Included Studies
• Step 7: Extract Data from Included Studies
• Step 8: Write the Review

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  Request a systematic or scoping review consultation

Search the FAQs

In Step 3, you will design a search strategy to find all of the articles related to your research question. You will:

• Define the main concepts of your topic
• Choose which databases you want to search
• List terms to describe each concept
• Add terms from controlled vocabulary like MeSH
• Use field tags to tell the database where to search for terms
• Combine terms and concepts with Boolean operators AND and OR
• Translate your search strategy to match the format standards for each database
• Save a copy of your search strategy and details about your search

There are many factors to think about when building a strong search strategy for systematic reviews. Librarians are available to provide support with this step of the process.

Click an item below to see how it applies to Step 3: Conduct Literature Searches.

Reporting your review with PRISMA

For PRISMA, there are specific items you will want to report from your search.  For this step, review the PRISMA-S checklist.

• PRISMA-S for Searching
• Specify all databases, registers, websites, organizations, reference lists, and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted. Present the full search strategies for all databases, registers and websites, including any filters and limits used.
• For information on how to document database searches and other search methods on your PRISMA flow diagram, visit our FAQs "How do I document database searches on my PRISMA flow diagram?" and "How do I document a grey literature search for my PRISMA flow diagram?"

Managing your review with Covidence

For this step of the review, in Covidence you can:

• Document searches in Covidence review settings so all team members can view
• Add keywords from your search to be highlighted in green or red while your team screens articles in your review settings

How a librarian can help with Step 3

When designing and conducting literature searches, a librarian can advise you on :

• How to create a search strategy with Boolean operators, database-specific syntax, subject headings, and appropriate keywords 
• How to apply previously published systematic review search strategies to your current search
• How to test your search strategy's performance 
• How to translate a search strategy from one database's preferred structure to another

The goal of a systematic retrieve is to find all results that are relevant to your topic. Because systematic review searches can be quite extensive and retrieve large numbers of results, an important aspect of systematic searching is limiting the number of irrelevant results that need to be screened. Librarians are experts trained in literature searching and systematic review methodology. Ask us a question or partner with a librarian to save time and improve the quality of your review. Our comparison chart detailing two tiers of partnership provides more information on how librarians can collaborate with and contribute to systematic review teams.

Search Process

• Use controlled vocabulary, if applicable
• Include synonyms/keyword terms
• Choose databases, websites, and/or registries to search
• Translate to other databases
• Search using other methods (e.g. hand searching)
• Validate and peer review the search

Databases can be multidisciplinary or subject specific. Choose the best databases for your research question. Databases index various journals, so in order to be comprehensive, it is important to search multiple databases when conducting a systematic review. Consider searching databases with more diverse or global coverage (i.e., Global Index Medicus) when appropriate. A list of frequently used databases is provided below. You can access UNC Libraries' full listing of databases on the HSL website (arranged alphabetically or by subject ).

Generally speaking, when literature searching, you are not searching the full-text article. Instead, you are searching certain citation data fields, like title, abstract, keyword, controlled vocabulary terms, and more. When developing a literature search, a good place to start is to identify searchable concepts of the research question, and then expand by adding other terms to describe those concepts. Read below for more information and examples on how to develop a literature search, as well as find tips and tricks for developing more comprehensive searches.

Identify search concepts and terms for each

Start by identifying the main concepts of your research question. If unsure, try using a question framework to help identify the main searchable concepts. PICO is one example of a question framework and is used specifically for clinical questions. If your research question doesn't fit into the PICO model well, view other examples of question frameworks and try another!

View our example in PICO format

Question: for patients 65 years and older, does an influenza vaccine reduce the future risk of pneumonia, controlled vocabulary.

Controlled vocabulary is a set of terminology assigned to citations to describe the content of each reference. Searching with controlled vocabulary can improve the relevancy of search results. Many databases assign controlled vocabulary terms to citations, but their naming schema is often specific to each database. For example, the controlled vocabulary system searchable via PubMed is MeSH, or Medical Subject Headings. More information on searching MeSH can be found on the HSL PubMed Ten Tips Legacy Guide .

Note: Controlled vocabulary may be outdated, and some databases allow users to submit requests to update terminology.

View Controlled Vocabulary for our example PICO

As mentioned above, databases with controlled vocabulary often use their own unique system. A listing of controlled vocabulary systems by database is shown below.

Keyword Terms

Not all citations are indexed with controlled vocabulary terms, however, so it is important to combine controlled vocabulary searches with keyword, or text word, searches. 

Authors often write about the same topic in varied ways and it is important to add these terms to your search in order to capture most of the literature. For example, consider these elements when developing a list of keyword terms for each concept:

• American versus British spelling
• hyphenated terms
• quality of life
• satisfaction
• vaccination
• influenza vaccination

There are several resources to consider when searching for synonyms. Scan the results of preliminary searches to identify additional terms. Look for synonyms, word variations, and other possibilities in Wikipedia, other encyclopedias or dictionaries, and databases. For example, PubChem lists additional drug names and chemical compounds.

Display Controlled Vocabulary and Keywords for our example PICO

Combining controlled vocabulary and text words in PubMed would look like this:

"Influenza Vaccines"[Mesh] OR "influenza vaccine" OR "influenza vaccines" OR "flu vaccine" OR "flu vaccines" OR "flu shot" OR "flu shots" OR "influenza virus vaccine" OR "influenza virus vaccines"

Social and cultural norms have been rapidly changing around the world. This has led to changes in the vocabulary used, such as when describing people or populations. Library and research terminology changes more slowly, and therefore can be considered outdated, unacceptable, or overly clinical for use in conversation or writing.

For our example with people 65 years and older, APA Style Guidelines recommend that researchers use terms like “older adults” and “older persons” and forgo terms like “senior citizens” and “elderly” that connote stereotypes. While these are current recommendations, researchers will recognize that terms like “elderly” have previously been used in the literature. Therefore, removing these terms from the search strategy may result in missed relevant articles. 

Research teams need to discuss current and outdated terminology and decide which terms to include in the search to be as comprehensive as possible. The research team or a librarian can search for currently preferred terms in glossaries, dictionaries, published guidelines, and governmental or organizational websites. The University of Michigan Library provides suggested wording to use in the methods section when antiquated, non-standard, exclusionary, or potentially offensive terms are included in the search.

Check the methods sections or supplementary materials of published systematic reviews for search strategies to see what terminology they used. This can help inform your search strategy by using MeSH terms or keywords you may not have thought of. However, be aware that search strategies will differ in their comprehensiveness.

You can also run a preliminary search for your topic, sort the results by Relevance or Best Match, and skim through titles and abstracts to identify terminology from relevant articles that you should include in your search strategy.

Nesting is a term that describes organizing search terms inside parentheses. This is important because, just like their function in math, commands inside a set of parentheses occur first. Parentheses let the database know in which order terms should be combined. 

Always combine terms for a single concept inside a parentheses set. For example: 

( "Influenza Vaccines"[Mesh] OR "influenza vaccine" OR "influenza vaccines" OR "flu vaccine" OR "flu vaccines" OR "flu shot" OR "flu shots" OR "influenza virus vaccine" OR "influenza virus vaccines" )

Additionally, you may nest a subset of terms for a concept inside a larger parentheses set, as seen below. Pay careful attention to the number of parenthesis sets and ensure they are matched, meaning for every open parentheses you also have a closed one.

( "Influenza Vaccines"[Mesh] OR "influenza vaccine" OR "influenza vaccines" OR "flu vaccine" OR "flu vaccines" OR "flu shot" OR "flu shots" OR "influenza virus vaccine" OR "influenza virus vaccines" OR   (( flu OR influenza ) AND ( vaccine OR vaccines OR vaccination OR immunization )))

Boolean operators

Boolean operators are used to combine terms in literature searches. Searches are typically organized using the Boolean operators OR or AND. OR is used to combine search terms for the same concept (i.e., influenza vaccine). AND is used to combine different concepts (i.e., influenza vaccine AND older adults AND pneumonia). An example of how Boolean operators can affect search retrieval is shown below. Using AND to combine the three concepts will only retrieve results where all are present. Using OR to combine the concepts will retrieve results that use all separately or together. It is important to note that, generally speaking, when you are performing a literature search you are only searching the title, abstract, keywords and other citation data. You are not searching the full-text of the articles.

The last major element to consider when building systematic literature searches are field tags. Field tags tell the database exactly where to search. For example, you can use a field tag to tell a database to search for a term in just the title, the title and abstract, and more. Just like with controlled vocabulary, field tag commands are different for every database.

If you do not manually apply field tags to your search, most databases will automatically search in a set of citation data points. Databases may also overwrite your search with algorithms if you do not apply field tags. For systematic review searching, best practice is to apply field tags to each term for reproducibility.

For example:

("Influenza Vaccines"[Mesh] OR "influenza vaccine"[tw] OR "influenza vaccines"[tw] OR "flu vaccine"[tw] OR "flu vaccines"[tw] OR "flu shot"[tw] OR "flu shots"[tw] OR "influenza virus vaccine"[tw] OR "influenza virus vaccines"[tw] OR ((flu[tw] OR influenza[tw]) AND (vaccine[tw] OR vaccines[tw] OR vaccination[tw] OR immunization[tw])))

View field tags for several health databases

For more information about how to use a variety of databases, check out our guides on searching.

• Searching PubMed guide Guide to searching Medline via the PubMed database
• Searching Embase guide Guide to searching Embase via embase.com
• Searching Scopus guide Guide to searching Scopus via scopus.com
• Searching EBSCO Databases guide Guide to searching CINAHL, PsycInfo, Global Health, & other databases via EBSCO

Combining search elements together

Organizational structure of literature searches is very important. Specifically, how terms are grouped (or nested) and combined with Boolean operators will drastically impact search results. These commands tell databases exactly how to combine terms together, and if done incorrectly or inefficiently, search results returned may be too broad or irrelevant.

For example, in PubMed:

(influenza OR flu) AND vaccine is a properly combined search and it produces around 50,000 results.

influenza OR flu AND vaccine is not properly combined.  Databases may read it as everything about influenza OR everything about (flu AND vaccine), which would produce more results than needed.

We recommend one or more of the following:

• put all your synonyms together inside a set of parentheses, then put AND between the closing parenthesis of one set and the opening parenthesis of the next set
• use a separate search box for each set of synonyms
• run each set of synonyms as a separate search, and then combine all your searches
• ask a librarian if your search produces too many or too few results

View the proper way to combine MeSH terms and Keywords for our example PICO

Question: for patients 65 years and older, does an influenza vaccine reduce the future risk of pneumonia , translating search strategies to other databases.

Databases often use their own set of terminology and syntax. When searching multiple databases, you need to adjust the search slightly to retrieve comparable results. Our sections on Controlled Vocabulary and Field Tags have information on how to build searches in different databases.  Resources to help with this process are listed below.

• Polyglot search A tool to translate a PubMed or Ovid search to other databases
• Search Translation Resources (Cornell) A listing of resources for search translation from Cornell University
• Advanced Searching Techniques (King's College London) A collection of advanced searching techniques from King's College London

Other searching methods

Hand searching.

Literature searches can be supplemented by hand searching. One of the most popular ways this is done with systematic reviews is by searching the reference list and citing articles of studies included in the review. Another method is manually browsing key journals in your field to make sure no relevant articles were missed. Other sources that may be considered for hand searching include: clinical trial registries, white papers and other reports, pharmaceutical or other corporate reports, conference proceedings, theses and dissertations, or professional association guidelines.

Searching grey literature

Grey literature typically refers to literature not published in a traditional manner and often not retrievable through large databases and other popular resources. Grey literature should be searched for inclusion in systematic reviews in order to reduce bias and increase thoroughness. There are several databases specific to grey literature that can be searched.

• Open Grey Grey literature for Europe
• OAIster A union catalog of millions of records representing open access resources from collections worldwide
• Grey Matters: a practical tool for searching health-related grey literature (CADTH) From CADTH, the Canadian Agency for Drugs and Technologies in Health, Grey Matters is a practical tool for searching health-related grey literature. The MS Word document covers a grey literature checklist, including national and international health technology assessment (HTA) web sites, drug and device regulatory agencies, clinical trial registries, health economics resources, Canadian health prevalence or incidence databases, and drug formulary web sites.
• Duke Medical Center Library: Searching for Grey Literature A good online compilation of resources by the Duke Medical Center Library.

Systematic review quality is highly dependent on the literature search(es) used to identify studies. To follow best practices for reporting search strategies, as well as increase reproducibility and transparency, document various elements of the literature search for your review. To make this process more clear, a statement and checklist for reporting literature searches has been developed and and can be found below.

• PRISMA-S: Reporting Literature Searches in Systematic Reviews
• Section 4.5 Cochrane Handbook - Documenting and reporting the search process

At a minimum, document and report certain elements, such as databases searched, including name (i.e., Scopus) and platform (i.e. Elsevier), websites, registries, and grey literature searched. In addition, this also may include citation searching and reaching out to experts in the field. Search strategies used in each database or source should be documented, along with any filters or limits, and dates searched. If a search has been updated or was built upon previous work, that should be noted as well. It is also helpful to document which search terms have been tested and decisions made for term inclusion or exclusion by the team. Last, any peer review process should be stated as well as the total number of records identified from each source and how deduplication was handled. 

If you have a librarian on your team who is creating and running the searches, they will handle the search documentation.

You can document search strategies in word processing software you are familiar with like Microsoft Word or Excel, or Google Docs or Sheets. A template, and separate example file, is provided below for convenience. 

• Search Strategy Documentation Template
• Search Strategy Documentation Example

*Some databases like PubMed are being continually updated with new technology and algorithms. This means that searches may retrieve different results than when originally run, even with the same filters, date limits, etc.

When you decide to update a systematic review search, there are two ways of identifying new articles:  

1. rerun the original search strategy without any changes. .

Rerun the original search strategy without making any changes.  Import the results into your citation manager, and remove all articles duplicated from the original set of search results.

2. Rerun the original search strategy and add an entry date filter.

Rerun the original search strategy and add a date filter for when the article was added to the database ( not the publication date).  An entry date filter will find any articles added to the results since you last ran the search, unlike a publication date filter, which would only find more recent articles.

Some examples of entry date filters for articles entered since December 31, 2021 are:

• PubMed:   AND ("2021/12/31"[EDAT] : "3000"[EDAT])
• Embase: AND [31-12-2021]/sd
• CINAHL:   AND EM 20211231-20231231
• PsycInfo: AND RD 20211231-20231231
• Scopus:   AND LOAD-DATE AFT 20211231  

Your PRISMA flow diagram

For more information about updating the PRISMA flow diagram for your systematic review, see the information on filling out a PRISMA flow diagram for review updates on the Step 8: Write the Review page of the guide.

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Literature Reviews & Search Strategies

• Defining the Literature Review
• Types of Literature Reviews
• Choosing Databases

Overview of Search Strategies

Search strategies, subject searching, example: iteratively developing + using keywords, demonstration: developing keywords from a question, demonstration: an advanced search.

• Organizing Your Literature
• Books: Research Design & Scholarly Writing
• Recommended Tutorials

There are many ways to find literature for your review, and we recommend that you use a combination of strategies - keeping in mind that you're going to be searching multiple times in a variety of ways, using different databases and resources. Searching the literature is not a straightforward, linear process - it's iterative (translation: you'll search multiple times, modifying your strategies as you go, and sometimes it'll be frustrating). 

• Known Item Searching
• Citation Jumping

Some form of a keyword search is the way most of us get at scholarly articles in database - it's a great approach! Make sure you're familiar with these librarian strategies to get the most out of your searches.

Figuring out the best keywords for your research topic/question is a process - you'll start with one or a few words and then shift, adapt, and expand them as you start finding source that describe the topic using other words. Your search terms are the bridge between known topics and the unknowns of your research question - so sometimes one specific word will be enough, sometimes you'll need several different words to describe a concept AND you'll need to connect that concept to a second (and/or third) concept.

The number and specificity of your search terms depend on your topic and the scope of your literature review.

Connect Keywords Using Boolean

Make the database work more.

...uses the asterisk (*) to end a word at its core, allowing you to retrieve many more documents containing variations of the search term.  Example: educat* will find educate, educates, education, educators, educating and more.

Phrase Searching

...is when you put quotations marks around two or more words, so that the database looks for those words in that exact order. Examples: "higher education," "public health" and "pharmaceutical industry."

Controlled Vocabulary

... is when you use the terms the database uses to describe what each article is about as search terms. Searching using controlled vocabularies is a great way to get at everything on a topic in a database.  

Databases and search engines are probably going to bring back a lot of results - more than a human can realistically go through. Instead of trying to manually read and sort them all, use the filters in each database to remove the stuff you wouldn't use anyway (ie it's outside the scope of your project).

To make sure you're consistent between searches and databases, write down the filters you're using.

A Few Filters to Try

Once you know you have a good article , there are a lot of useful parts to it - far beyond the content.

Not sure where to start? Try course readings and other required materials.

Useful Parts of a Good Article

Ways to use citations.

• Interactive Tutorial: Searching Cited and Citing Practice starting your search at an article and using the references to gather additional sources.

Your search results don't have to be frozen in the moment you search! There are a few things you can set up to keep your search going automatically.

Searching using subject headings is a comprehensive search strategy that requires some planning and topic knowledge. Work through this PubMed tutorial for an introduction to this important approach to searching.

Through these videos and the accompanying PDF, you'll see an example of starting with a potential research question and developing search terms through brainstorming and keyword searching.

• Slidedeck: Keywords and Advanced Search PowerPoint slides to accompany the two demonstration videos on developing keywords from a question, and doing an advanced search.
• << Previous: Choosing Databases
• Next: Organizing Your Literature >>
• Last Updated: Jun 14, 2023 11:18 AM
• URL: https://mcphs.libguides.com/litreviews

Conducting a Literature Review

• Getting Started
• Developing a Question
• Searching the Literature
• Identifying Peer-Reviewed Resources
• Managing Results
• Analyzing the Literature
• Writing the Review

Need Help? Ask Your librarian!

Search Strategies

• Boolean Operators

Once you have identified the key concepts of your research question (see "Developing a Question"), you can use those concepts to develop keywords for your search strategy. The following tips and techniques will help you design a precise and relevant search strategy.

Keywords are any words you might use to search the record of an article, book, or other material in library databases. The database searches through the metadata (such as title, authors, publication, abstract, etc.) to find resources that contain the word you searched, and may also search through the full text of the material.

Keywords are most successful when you're searching for the words that the authors use to describe the research topic, as most databases will search for those specific words within the record of the article. To increase your chance of returning relevant results, consider all of the words that  might  be used to describe the research you're trying to find, and try some of these out in sample searches to determine which words return the best results.

Search Tips - Keywords

• Search for singular and plural terms together: (physician OR physicians)
• Search for both the American and British spelling of words: (behavior OR behaviour)
• Search for synonyms of terms together: (teenager OR adolescent)
• Search for phrases inside of quotation marks: ("young adult")

Use Boolean operators to combine keywords for more precise search results. 

AND - If the term must be included in your search:

influenza AND vaccine

OR - If terms are interchangeable, i.e. synonyms. Place OR'd terms within parentheses:

(influenza OR flu) AND vaccine

NOT - If a term should not be included in your search. This Boolean operator is rarely necessary for literature reviews.

(influenza OR flu) AND vaccine NOT H1N1

Note how we've used parentheses in the examples above. Search strings like these are similar to mathematical equations, where you perform the actions within the parentheses before proceeding from left to right to run the search. For example, using the search [(influenza OR flu) AND vaccine] will find results that have a term relating to influenza/flu, as well as the term vaccine.

If we moved the parentheses, it would be a very different search. [influenza OR (flu AND vaccine)] will provide results that use the term influenza, as well as results that use both the terms flu and vaccine. This means you would get results having to do with influenza but perhaps nothing to do with vaccination. 

Here are a few examples of how this search would be different depending on the arrangement of booleans and keywords. The area highlighted in pink represents the search results that would be returned with this search.

Truncation allows you to quickly include all variations of a word in your search. Use the root of the keyword and add an asterisk (*). For example:

nurs* = nurse, nurses, nursing, nursery

IMPORTANT: Notice that "nursery" is also retrieved in the above search. Truncation will save you from having to include a large number of synonyms, but it will also add a certain number of irrelevant results. You can limit this effect by using the NOT Boolean operator, i.e. NOT nursery.

Wild cards allow you to replace a letter in a keyword to retrieve all variations of the spelling. For example:

p?ediatric = pediatric, paediatric

Free-Text vs. Thesaurus Searching

While you can search any word as a keyword, databases also contain an official list of the terms they use to describe the subject of each article, called Subject Headings. You can look up Subject Headings in the thesaurus of the database, using the thesaurus's search box to pull up the recommended Subject Heading for a given keyword. When searching specifically for Subject Headings, the database will only search the Subject Headings field within the record of each article (ie, not the title, abstract, etc.). This is a much more targeted method of searching, and is an excellent addition to your search strategy. 

A strong search strategy will use both free-text (keyword) searching and thesaurus searching, to ensure that all relevant articles have been retrieved by the search. The lists below outline the strengths and weaknesses of both types of search strategies.

Free-Text Searching

• Natural language words describing your topic
• More flexible search strategy - can use any term in any combination
• Database looks for keywords anywhere in the record - not necessarily connected together
• May yield too many or too few results
• May yield many irrelevant results

Thesaurus Searching

• Pre-defined "controlled vocabulary" words used to describe the content of each item in a database
• Less flexible search strategy - need to know the exact controlled vocabulary term
• Database looks for subjects only in the subject heading or descriptor field, where the most relevant words appear
• If too many results, you can use subheadings to focus on one aspect of a broader topic
• Results are usually very relevant to the topic

MIT Libraries. Database Search Tips: Keywords vs. Subjects. https://libguides.mit.edu/c.php?g=175963&p=1160804

Each database has their own thesaurus. You will need to adapt your search strategy for each database to take advantage of their unique thesaurus.

PubMed uses MeSH terms (Medical Subject Headings). You can learn more about finding and using MeSH terms here:

• The Basics of Medical Subject Headings (MeSH) in MEDLINE/PubMed: A Tutorial

CINAHL uses CINAHL Headings. You can learn more about finding and use these terms here:

• Using CINAHL/MeSH Headings

In other databases, look for a link with the terms "headings", "subject headings", or "thesaurus" to find the appropriate thesaurus terms for your search.

Citation Searching

Citation searching is a search strategy that allows you to search either forward or backwards time through the literature based on an identified relevant article:

You can search forward in time by using databases that allow you to search for other articles that have cited the identified relevant article. (Web of Science and Google Scholar can do this automatically.)

• Web of Science (Clarivate Analytics)
• Google Scholar

You can search backward in time by reviewing the reference list of the identified relevant article for additional article citations.

For more information about how to perform citation searches, check out this guide from the University of Toledo Libraries:

• How To: Cited Reference Searches in Web of Science Guide from the University of Toledo

Retrieving Materials

Select a database.

When searching for articles, it is best to use an appropriate subject database rather than the SearchIT catalog. Be sure to select your database from the Spokane Academic Library homepage to ensure that you will have access to full-text articles.

"Find It @ WSU" Button in PubMed

When you have found an article that you would like to read in its entirety, look for the "Find It @ WSU" Button. This button will take you to the article entry in the SearchIT catalog.

Here's what that looks like in PubMed.

"Find It @ WSU" Button in CINAHL

"Find It @ WSU" Button in PsycINFO

Accessing the Full-Text Article

After selecting the "Find It @ WSU" Button, you will be taken to the article entry in SearchIT. Select the link under the Access Options box to be directed to the full-text article. 

If an article is not available in the WSU Libraries collection, you can request the article through interlibrary loan by selecting the link under "Access Options".

See the Using Interlibrary Loan section for more information.

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• Last Updated: Apr 16, 2024 3:40 PM
• URL: https://libguides.libraries.wsu.edu/litreview

• Interlibrary Loan

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Ask an expert about access to resources, publishing, grants, and more.

MD Anderson faculty and staff can also request a one-on-one consultation with a librarian or scientific editor.

• Library Calendar

Log in to the Library's remote access system using your MyID account.

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Literature Search Basics

Develop a search strategy.

• Define your search
• Decide where to search

What is a search strategy

Advanced search tips.

• Track and save your search
• Class Recording: Writing an Effective Narrative Review
• A search strategy includes  a combination of keywords, subject headings, and limiters (language, date, publication type, etc.)
• A search strategy should be planned out and practiced before executing the final search in a database.
• A search strategy and search results should be documented throughout the searching process.

What is a search strategy?

A search strategy is an organized combination of keywords, phrases, subject headings, and limiters used to search a database.

Your search strategy will include:

• keywords 
• boolean operators
• variations of search terms (synonyms, suffixes)
• subject headings 

Your search strategy  may  include:

• truncation (where applicable)
• phrases (where applicable)
• limiters (date, language, age, publication type, etc.)

A search strategy usually requires several iterations. You will need to test the strategy along the way to ensure that you are finding relevant articles. It's also a good idea to review your search strategy with your co-authors. They may have ideas about terms or concepts you may have missed.

Additionally, each database you search is developed differently. You will need to adjust your strategy for each database your search.  For instance, Embase is a European database, many of the medical terms are slightly different than those used in MEDLINE and PubMed.

Choose search terms

Start by writing down as many terms as you can think of that relate to your question. You might try  cited reference searching  to find a few good articles that you can review for relevant terms.

Remember than most terms or  concepts can be expressed in different ways.  A few things to consider:

• synonyms: "cancer" may be referred to as "neoplasms", "tumors", or "malignancy"
• abbreviations: spell out the word instead of abbreviating
• generic vs. trade names of drugs

Search for the exact phrase

If you want words to appear next to each other in an exact phrase, use quotation marks, eg “self-esteem”.

Phrase searching decreases the number of results you get. Most databases allow you to search for phrases, but check the database guide if you are unsure.

Truncation and wildcards

Many databases use an asterisk (*) as their truncation symbol  to find various word endings like singulars and plurals.  Check the database help section if you are not sure which symbol to use. 

"Therap*"

retrieves: therapy, therapies, therapist or therapists.

Use a wildcard (?) to find different spellings like British and American spellings.

"Behavio?r" retrieves behaviour and behavior.

Searching with subject headings

Database subject headings are controlled vocabulary terms that a database uses to describe what an article is about.

Using appropriate subject headings enhances your search and will help you to find more results on your topic. This is because subject headings find articles according to their subject, even if the article does not use your chosen key words.

You should combine both subject headings and keywords in your search strategy for each of the concepts you identify. This is particularly important if you are undertaking a systematic review or an in-depth piece of work

Subject headings may vary between databases, so you need to investigate each database separately to find the subject headings they use. For example, for MEDLINE you can use MeSH (Medical Subject Headings) and for Embase you can use the EMTREE thesaurus.

SEARCH TIP:  In Ovid databases, search for a known key paper by title, select the "complete reference" button to see which subject headings the database indexers have given that article, and consider adding relevant ones to your own search strategy.

Use Boolean logic to combine search terms

Boolean operators (AND, OR and NOT) allow you to try different combinations of search terms or subject headings.

Databases often show Boolean operators as buttons or drop-down menus that you can click to combine your search terms or results.

The main Boolean operators are:

OR is used to find articles that mention  either  of the topics you search for.

AND is used to find articles that mention  both  of the searched topics.

NOT excludes a search term or concept. It should be used with caution as you may inadvertently exclude relevant references.

For example, searching for “self-esteem NOT eating disorders” finds articles that mention self-esteem but removes any articles that mention eating disorders.

Adjacency searching 

Use adjacency operators to search by phrase or with two or more words in relation to one another. A djacency searching commands differ among databases. Check the database help section if you are not sure which searching commands to use. 

In Ovid Medline

"breast ADJ3 cancer" finds the word breast within three words of cancer, in any order.

This includes breast cancer or cancer of the breast.

Cited Reference Searching

Cited reference searching is a method to find articles that have been cited by other publications. 

Use cited reference searching to:

• find keywords or terms you may need to include in your search strategy
• find pivotal papers the same or similar subject area
• find pivotal authors in the same or similar subject area
• track how a topic has developed over time

Cited reference searching is available through these tools:

• Web of Science
• GoogleScholar
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Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

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• Journal List
• J Med Libr Assoc
• v.106(4); 2018 Oct

A systematic approach to searching: an efficient and complete method to develop literature searches

Associated data.

Creating search strategies for systematic reviews, finding the best balance between sensitivity and specificity, and translating search strategies between databases is challenging. Several methods describe standards for systematic search strategies, but a consistent approach for creating an exhaustive search strategy has not yet been fully described in enough detail to be fully replicable. The authors have established a method that describes step by step the process of developing a systematic search strategy as needed in the systematic review. This method describes how single-line search strategies can be prepared in a text document by typing search syntax (such as field codes, parentheses, and Boolean operators) before copying and pasting search terms (keywords and free-text synonyms) that are found in the thesaurus. To help ensure term completeness, we developed a novel optimization technique that is mainly based on comparing the results retrieved by thesaurus terms with those retrieved by the free-text search words to identify potentially relevant candidate search terms. Macros in Microsoft Word have been developed to convert syntaxes between databases and interfaces almost automatically. This method helps information specialists in developing librarian-mediated searches for systematic reviews as well as medical and health care practitioners who are searching for evidence to answer clinical questions. The described method can be used to create complex and comprehensive search strategies for different databases and interfaces, such as those that are needed when searching for relevant references for systematic reviews, and will assist both information specialists and practitioners when they are searching the biomedical literature.

INTRODUCTION

Librarians and information specialists are often involved in the process of preparing and completing systematic reviews (SRs), where one of their main tasks is to identify relevant references to include in the review [ 1 ]. Although several recommendations for the process of searching have been published [ 2 – 6 ], none describe the development of a systematic search strategy from start to finish.

Traditional methods of SR search strategy development and execution are highly time consuming, reportedly requiring up to 100 hours or more [ 7 , 8 ]. The authors wanted to develop systematic and exhaustive search strategies more efficiently, while preserving the high sensitivity that SR search strategies necessitate. In this article, we describe the method developed at Erasmus University Medical Center (MC) and demonstrate its use through an example search. The efficiency of the search method and outcome of 73 searches that have resulted in published reviews are described in a separate article [ 9 ].

As we aimed to describe the creation of systematic searches in full detail, the method starts at a basic level with the analysis of the research question and the creation of search terms. Readers who are new to SR searching are advised to follow all steps described. More experienced searchers can consider the basic steps to be existing knowledge that will already be part of their normal workflow, although step 4 probably differs from general practice. Experienced searchers will gain the most from reading about the novelties in the method as described in steps 10–13 and comparing the examples given in the supplementary appendix to their own practice.

CREATING A SYSTEMATIC SEARCH STRATEGY

Our methodology for planning and creating a multi-database search strategy consists of the following steps:

• Determine a clear and focused question
• Describe the articles that can answer the question
• Decide which key concepts address the different elements of the question
• Decide which elements should be used for the best results
• Choose an appropriate database and interface to start with
• Document the search process in a text document
• Identify appropriate index terms in the thesaurus of the first database
• Identify synonyms in the thesaurus
• Add variations in search terms
• Use database-appropriate syntax, with parentheses, Boolean operators, and field codes
• Optimize the search
• Evaluate the initial results
• Check for errors
• Translate to other databases
• Test and reiterate

Each step in the process is reflected by an example search described in the supplementary appendix .

1. Determine a clear and focused question

A systematic search can best be applied to a well-defined and precise research or clinical question. Questions that are too broad or too vague cannot be answered easily in a systematic way and will generally result in an overwhelming number of search results. On the other hand, a question that is too specific will result into too few or even zero search results. Various papers describe this process in more detail [ 10 – 12 ].

2. Describe the articles that can answer the question

Although not all clinical or research questions can be answered in the literature, the next step is to presume that the answer can indeed be found in published studies. A good starting point for a search is hypothesizing what the research that can answer the question would look like. These hypothetical (when possible, combined with known) articles can be used as guidance for constructing the search strategy.

3. Decide which key concepts address the different elements of the question

Key concepts are the topics or components that the desired articles should address, such as diseases or conditions, actions, substances, settings, domains (e.g., therapy, diagnosis, etiology), or study types. Key concepts from the research question can be grouped to create elements in the search strategy.

Elements in a search strategy do not necessarily follow the patient, intervention, comparison, outcome (PICO) structure or any other related structure. Using the PICO or another similar framework as guidance can be helpful to consider, especially in the inclusion and exclusion review stage of the SR, but this is not necessary for good search strategy development [ 13 – 15 ]. Sometimes concepts from different parts of the PICO structure can be grouped together into one search element, such as when the desired outcome is frequently described in a certain study type.

4. Decide which elements should be used for the best results

Not all elements of a research question should necessarily be used in the search strategy. Some elements are less important than others or may unnecessarily complicate or restrict a search strategy. Adding an element to a search strategy increases the chance of missing relevant references. Therefore, the number of elements in a search strategy should remain as low as possible to optimize recall.

Using the schema in Figure 1 , elements can be ordered by their specificity and importance to determine the best search approach. Whether an element is more specific or more general can be measured objectively by the number of hits retrieved in a database when searching for a key term representing that element. Depending on the research question, certain elements are more important than others. If articles (hypothetically or known) exist that can answer the question but lack a certain element in their titles, abstracts, or keywords, that element is unimportant to the question. An element can also be unimportant because of expected bias or an overlap with another element.

Schema for determining the optimal order of elements

Bias in elements

The choice of elements in a search strategy can introduce bias through use of overly specific terminology or terms often associated with positive outcomes. For the question “does prolonged breastfeeding improve intelligence outcomes in children?,” searching specifically for the element of duration will introduce bias, as articles that find a positive effect of prolonged breastfeeding will be much more likely to mention time factors in their titles or abstracts.

Overlapping elements

Elements in a question sometimes overlap in their meaning. Sometimes certain therapies are interventions for one specific disease. The Lichtenstein technique, for example, is a repair method for inguinal hernias. There is no need to include an element of “inguinal hernias” to a search for the effectiveness of the Lichtenstein therapy. Likewise, sometimes certain diseases are only found in certain populations. Adding such an overlapping element could lead to missing relevant references.

The elements to use in a search strategy can be found in the plot of elements in Figure 1 , by following the top row from left to right. For this method, we recommend starting with the most important and specific elements. Then, continue with more general and important elements until the number of results is acceptable for screening. Determining how many results are acceptable for screening is often a matter of negotiation with the SR team.

5. Choose an appropriate database and interface to start with

Important factors for choosing databases to use are the coverage and the presence of a thesaurus. For medically oriented searches, the coverage and recall of Embase, which includes the MEDLINE database, are superior to those of MEDLINE [ 16 ]. Each of these two databases has its own thesaurus with its own unique definitions and structure. Because of the complexity of the Embase thesaurus, Emtree, which contains much more specific thesaurus terms than the MEDLINE Medical Subject Headings (MeSH) thesaurus, translation from Emtree to MeSH is easier than the other way around. Therefore, we recommend starting in Embase.

MEDLINE and Embase are available through many different vendors and interfaces. The choice of an interface and primary database is often determined by the searcher’s accessibility. For our method, an interface that allows searching with proximity operators is desirable, and full functionality of the thesaurus, including explosion of narrower terms, is crucial. We recommend developing a personal workflow that always starts with one specific database and interface.

6. Document the search process in a text document

We advise designing and creating the complete search strategies in a log document, instead of directly in the database itself, to register the steps taken and to make searches accountable and reproducible. The developed search strategies can be copied and pasted into the desired databases from the log document. This way, the searcher is in control of the whole process. Any change to the search strategy should be done in the log document, assuring that the search strategy in the log is always the most recent.

7. Identify appropriate index terms in the thesaurus of the first database

Searches should start by identifying appropriate thesaurus terms for the desired elements. The thesaurus of the database is searched for matching index terms for each key concept. We advise restricting the initial terms to the most important and most relevant terms. Later in the process, more general terms can be added in the optimization process, in which the effect on the number of hits, and thus the desirability of adding these terms, can be evaluated more easily.

Several factors can complicate the identification of thesaurus terms. Sometimes, one thesaurus term is found that exactly describes a specific element. In contrast, especially in more general elements, multiple thesaurus terms can be found to describe one element. If no relevant thesaurus terms have been found for an element, free-text terms can be used, and possible thesaurus terms found in the resulting references can be added later (step 11).

Sometimes, no distinct thesaurus term is available for a specific key concept that describes the concept in enough detail. In Emtree, one thesaurus term often combines two or more elements. The easiest solution for combining these terms for a sensitive search is to use such a thesaurus term in all elements where it is relevant. Examples are given in the supplementary appendix .

8. Identify synonyms in the thesaurus

Most thesauri offer a list of synonyms on their term details page (named Synonyms in Emtree and Entry Terms in MeSH). To create a sensitive search strategy for SRs, these terms need to be searched as free-text keywords in the title and abstract fields, in addition to searching their associated thesaurus terms.

The Emtree thesaurus contains more synonyms (300,000) than MeSH does (220,000) [ 17 ]. The difference in number of terms is even higher considering that many synonyms in MeSH are permuted terms (i.e., inversions of phrases using commas).

Thesaurus terms are ordered in a tree structure. When searching for a more general thesaurus term, the more specific (narrower) terms in the branches below that term will also be searched (this is frequently referred to as “exploding” a thesaurus term). However, to perform a sensitive search, all relevant variations of the narrower terms must be searched as free-text keywords in the title or abstract, in addition to relying on the exploded thesaurus term. Thus, all articles that describe a certain narrower topic in their titles and abstracts will already be retrieved before MeSH terms are added.

9. Add variations in search terms (e.g., truncation, spelling differences, abbreviations, opposites)

Truncation allows a searcher to search for words beginning with the same word stem. A search for therap* will, thus, retrieve therapy, therapies, therapeutic, and all other words starting with “therap.” Do not truncate a word stem that is too short. Also, limitations of interfaces should be taken into account, especially in PubMed, where the number of search term variations that can be found by truncation is limited to 600.

Databases contain references to articles using both standard British and American English spellings. Both need to be searched as free-text terms in the title and abstract. Alternatively, many interfaces offer a certain code to replace zero or one characters, allowing a search for “pediatric” or “paediatric” as “p?ediatric.” Table 1 provides a detailed description of the syntax for different interfaces.

Field codes in five most used interfaces for biomedical literature searching

Searching for abbreviations can identify extra, relevant references and retrieve more irrelevant ones. The search can be more focused by combining the abbreviation with an important word that is relevant to its meaning or by using the Boolean “NOT” to exclude frequently observed, clearly irrelevant results. We advise that searchers do not exclude all possible irrelevant meanings, as it is very time consuming to identify all the variations, it will result in unnecessarily complicated search strategies, and it may lead to erroneously narrowing the search and, thereby, reduce recall.

Searching partial abbreviations can be useful for retrieving relevant references. For example, it is very likely that an article would mention osteoarthritis (OA) early in the abstract, replacing all further occurrences of osteoarthritis with OA . Therefore, it may not contain the phrase “hip osteoarthritis” but only “hip oa.”

It is also important to search for the opposites of search terms to avoid bias. When searching for “disease recurrence,” articles about “disease free” may be relevant as well. When the desired outcome is survival , articles about mortality may be relevant.

10. Use database-appropriate syntax, with parentheses, Boolean operators, and field codes

Different interfaces require different syntaxes, the special set of rules and symbols unique to each database that define how a correctly constructed search operates. Common syntax components include the use of parentheses and Boolean operators such as “AND,” “OR,” and “NOT,” which are available in all major interfaces. An overview of different syntaxes for four major interfaces for bibliographic medical databases (PubMed, Ovid, EBSCOhost, Embase.com, and ProQuest) is shown in Table 1 .

Creating the appropriate syntax for each database, in combination with the selected terms as described in steps 7–9, can be challenging. Following the method outlined below simplifies the process:

• Create single-line queries in a text document (not combining multiple record sets), which allows immediate checking of the relevance of retrieved references and efficient optimization.
• Type the syntax (Boolean operators, parentheses, and field codes) before adding terms, which reduces the chance that errors are made in the syntax, especially in the number of parentheses.
• Use predefined proximity structures including parentheses, such as (() ADJ3 ()) in Ovid, that can be reused in the query when necessary.
• Use thesaurus terms separately from free-text terms of each element. Start an element with all thesaurus terms (using “OR”) and follow with the free-text terms. This allows the unique optimization methods as described in step 11.
• When adding terms to an existing search strategy, pay close attention to the position of the cursor. Make sure to place it appropriately either in the thesaurus terms section, in the title/abstract section, or as an addition (broadening) to an existing proximity search.

The supplementary appendix explains the method of building a query in more detail, step by step for different interfaces: PubMed, Ovid, EBSCOhost, Embase.com, and ProQuest. This method results in a basic search strategy designed to retrieve some relevant references upon which a more thorough search strategy can be built with optimization such as described in step 11.

11. Optimize the search

The most important question when performing a systematic search is whether all (or most) potentially relevant articles have been retrieved by the search strategy. This is also the most difficult question to answer, since it is unknown which and how many articles are relevant. It is, therefore, wise first to broaden the initial search strategy, making the search more sensitive, and then check if new relevant articles are found by comparing the set results (i.e., search for Strategy #2 NOT Strategy #1 to see the unique results).

A search strategy should be tested for completeness. Therefore, it is necessary to identify extra, possibly relevant search terms and add them to the test search in an OR relationship with the already used search terms. A good place to start, and a well-known strategy, is scanning the top retrieved articles when sorted by relevance, looking for additional relevant synonyms that could be added to the search strategy.

We have developed a unique optimization method that has not been described before in the literature. This method often adds valuable extra terms to our search strategy and, therefore, extra, relevant references to our search results. Extra synonyms can be found in articles that have been assigned a certain set of thesaurus terms but that lack synonyms in the title and/or abstract that are already present in the current search strategy. Searching for thesaurus terms NOT free-text terms will help identify missed free-text terms in the title or abstract. Searching for free-text terms NOT thesaurus terms will help identify missed thesaurus terms. If this is done repeatedly for each element, leaving the rest of the query unchanged, this method will help add numerous relevant terms to the query. These steps are explained in detail for five different search platforms in the supplementary appendix .

12. Evaluate the initial results

The results should now contain relevant references. If the interface allows relevance ranking, use that in the evaluation. If you know some relevant references that should be included in the research, search for those references specifically; for example, combine a specific (first) author name with a page number and the publication year. Check whether those references are retrieved by the search. If the known relevant references are not retrieved by the search, adapt the search so that they are. If it is unclear which element should be adapted to retrieve a certain article, combine that article with each element separately.

Different outcomes are desired for different types of research questions. For instance, in the case of clinical question answering, the researcher will not be satisfied with many references that contain a lot of irrelevant references. A clinical search should be rather specific and is allowed to miss a relevant reference. In the case of an SR, the researchers do not want to miss any relevant reference and are willing to handle many irrelevant references to do so. The search for references to include in an SR should be very sensitive: no included reference should be missed. A search that is too specific or too sensitive for the intended goal can be adapted to become more sensitive or specific. Steps to increase sensitivity or specificity of a search strategy can be found in the supplementary appendix .

13. Check for errors

Errors might not be easily detected. Sometimes clues can be found in the number of results, either when the number of results is much higher or lower than expected or when many retrieved references are not relevant. However, the number expected is often unknown, and very sensitive search strategies will always retrieve many irrelevant articles. Each query should, therefore, be checked for errors.

One of the most frequently occurring errors is missing the Boolean operator “OR.” When no “OR” is added between two search terms, many interfaces automatically add an “AND,” which unintentionally reduces the number of results and likely misses relevant references. One good strategy to identify missing “OR”s is to go to the web page containing the full search strategy, as translated by the database, and using Ctrl-F search for “AND.” Check whether the occurrences of the “AND” operator are deliberate.

Ideally, search strategies should be checked by other information specialists [ 18 ]. The Peer Review of Electronic Search Strategies (PRESS) checklist offers good guidance for this process [ 4 ]. Apart from the syntax (especially Boolean operators and field codes) of the search strategy, it is wise to have the search terms checked by the clinician or researcher familiar with the topic. At Erasmus MC, researchers and clinicians are involved during the complete process of structuring and optimizing the search strategy. Each word is added after the combined decision of the searcher and the researcher, with the possibility of directly comparing results with and without the new term.

14. Translate to other databases

To retrieve as many relevant references as possible, one has to search multiple databases. Translation of complex and exhaustive queries between different databases can be very time consuming and cumbersome. The single-line search strategy approach detailed above allows quick translations using the find and replace method in Microsoft Word (<Ctrl-H>).

At Erasmus MC, macros based on the find-and-replace method in Microsoft Word have been developed for easy and fast translation between the most used databases for biomedical and health sciences questions. The schema that is followed for the translation between databases is shown in Figure 2 . Most databases simply follow the structure set by the Embase.com search strategy. The translation from Emtree terms to MeSH terms for MEDLINE in Ovid often identifies new terms that need to be added to the Embase.com search strategy before the translation to other databases.

Schematic representation of translation between databases used at Erasmus University Medical Center

Dotted lines represent databases that are used in less than 80% of the searches.

Using five different macros, a thoroughly optimized query in Embase.com can be relatively quickly translated into eight major databases. Basic search strategies will be created to use in many, mostly smaller, databases, because such niche databases often do not have extensive thesauri or advanced syntax options. Also, there is not much need to use extensive syntax because the number of hits and, therefore, the amount of noise in these databases is generally low. In MEDLINE (Ovid), PsycINFO (Ovid), and CINAHL (EBSCOhost), the thesaurus terms must be adapted manually, as each database has its own custom thesaurus. These macros and instructions for their installation, use, and adaptation are available at bit.ly/databasemacros.

15. Test and reiterate

Ideally, exhaustive search strategies should retrieve all references that are covered in a specific database. For SR search strategies, checking searches for their recall is advised. This can be done after included references have been determined by the authors of the systematic review. If additional papers have been identified through other non-database methods (i.e., checking references in included studies), results that were not identified by the database searches should be examined. If these results were available in the databases but not located by the search strategy, the search strategy should be adapted to try to retrieve these results, as they may contain terms that were omitted in the original search strategies. This may enable the identification of additional relevant results.

A methodology for creating exhaustive search strategies has been created that describes all steps of the search process, starting with a question and resulting in thorough search strategies in multiple databases. Many of the steps described are not new, but together, they form a strong method creating high-quality, robust searches in a relatively short time frame.

Our methodology is intended to create thoroughness for literature searches. The optimization method, as described in step 11, will identify missed synonyms or thesaurus terms, unlike any other method that largely depends on predetermined keywords and synonyms. Using this method results in a much quicker search process, compared to traditional methods, especially because of the easier translation between databases and interfaces (step 13). The method is not a guarantee for speed, since speed depends on many factors, including experience. However, by following the steps and using the tools as described above, searchers can gain confidence first and increase speed through practice.

What is new?

This method encourages searchers to start their search development process using empty syntax first and later adding the thesaurus terms and free-text synonyms. We feel this helps the searcher to focus on the search terms, instead of on the structure of the search query. The optimization method in which new terms are found in the already retrieved articles is used in some other institutes as well but has to our knowledge not been described in the literature. The macros to translate search strategies between interfaces are unique in this method.

What is different compared to common practice?

Traditionally, librarians and information specialists have focused on creating complex, multi-line (also called line-by-line) search strategies, consisting of multiple record sets, and this method is frequently advised in the literature and handbooks [ 2 , 19 – 21 ]. Our method, instead, uses single-line searches, which is critical to its success. Single-line search strategies can be easily adapted by adding or dropping a term without having to recode numbers of record sets, which would be necessary in multi-line searches. They can easily be saved in a text document and repeated by copying and pasting for search updates. Single-line search strategies also allow easy translation to other syntaxes using find-and-replace technology to update field codes and other syntax elements or using macros (step 13).

When constructing a search strategy, the searcher might experience that certain parentheses in the syntax are unnecessary, such as parentheses around all search terms in the title/abstract portion, if there is only one such term, there are double parentheses in the proximity statement, or one of the word groups exists for only one word. One might be tempted to omit those parentheses for ease of reading and management. However, during the optimization process, the searcher is likely to find extra synonyms that might consist of one word. To add those terms to the first query (with reduced parentheses) requires adding extra parentheses (meticulously placing and counting them), whereas, in the latter search, it only requires proper placement of those terms.

Many search methods highly depend on the PICO framework. Research states that often PICO or PICOS is not suitable for every question [ 22 , 23 ]. There are other acronyms than PICO—such as sample, phenomenon of interest, design, evaluation, research type (SPIDER) [ 24 ]—but each is just a variant. In our method, the most important and specific elements of a question are being analyzed for building the best search strategy.

Though it is generally recommended that searchers search both MEDLINE and Embase, most use MEDLINE as the starting point. It is considered the gold standard for biomedical searching, partially due to historical reasons, since it was the first of its kind, and more so now that it is freely available via the PubMed interface. Our method can be used with any database as a starting point, but we use Embase instead of MEDLINE or another database for a number of reasons. First, Embase provides both unique content and the complete content of MEDLINE. Therefore, searching Embase will be, by definition, more complete than searching MEDLINE only. Second, the number of terms in Emtree (the Embase thesaurus) is three times as high as that of MeSH (the MEDLINE thesaurus). It is easier to find MeSH terms after all relevant Emtree terms have been identified than to start with MeSH and translate to Emtree.

At Erasmus MC, the researchers sit next to the information specialist during most of the search strategy design process. This way, the researchers can deliver immediate feedback on the relevance of proposed search terms and retrieved references. The search team then combines knowledge about databases with knowledge about the research topic, which is an important condition to create the highest quality searches.

Limitations of the method

One disadvantage of single-line searches compared to multi-line search strategies is that errors are harder to recognize. However, with the methods for optimization as described (step 11), errors are recognized easily because missed synonyms and spelling errors will be identified during the process. Also problematic is that more parentheses are needed, making it more difficult for the searcher and others to assess the logic of the search strategy. However, as parentheses and field codes are typed before the search terms are added (step 10), errors in parentheses can be prevented.

Our methodology works best if used in an interface that allows proximity searching. It is recommended that searchers with access to an interface with proximity searching capabilities select one of those as the initial database to develop and optimize the search strategy. Because the PubMed interface does not allow proximity searches, phrases or Boolean “AND” combinations are required. Phrase searching complicates the process and is more specific, with the higher risk of missing relevant articles, and using Boolean “AND” combinations increases sensitivity but at an often high loss of specificity. Due to some searchers’ lack of access to expensive databases or interfaces, the freely available PubMed interface may be necessary to use, though it should never be the sole database used for an SR [ 2 , 16 , 25 ]. A limitation of our method is that it works best with subscription-based and licensed resources.

Another limitation is the customization of the macros to a specific institution’s resources. The macros for the translation between different database interfaces only work between the interfaces as described. To mitigate this, we recommend using the find-and-replace functionality of text editors like Microsoft Word to ease the translation of syntaxes between other databases. Depending on one’s institutional resources, custom macros can be developed using similar methods.

Results of the method

Whether this method results in exhaustive searches where no important article is missed is difficult to determine, because the number of relevant articles is unknown for any topic. A comparison of several parameters of 73 published reviews that were based on a search developed with this method to 258 reviews that acknowledged information specialists from other Dutch academic hospitals shows that the performance of the searches following our method is comparable to those performed in other institutes but that the time needed to develop the search strategies was much shorter than the time reported for the other reviews [ 9 ].

CONCLUSIONS

With the described method, searchers can gain confidence in their search strategies by finding many relevant words and creating exhaustive search strategies quickly. The approach can be used when performing SR searches or for other purposes such as answering clinical questions, with different expectations of the search’s precision and recall. This method, with practice, provides a stepwise approach that facilitates the search strategy development process from question clarification to final iteration and beyond.

SUPPLEMENTAL FILE

Acknowledgments.

We highly appreciate the work that was done by our former colleague Louis Volkers, who in his twenty years as an information specialist in Erasmus MC laid the basis for our method. We thank Professor Oscar Franco for reviewing earlier drafts of this article.