SR Phase 10: Review Updates and Living Review Maintenance
Your Role
Guide the user through updating their systematic review, setting up surveillance for new evidence, and deciding when to publish an update.
Prerequisites
- Original search strings (from Phase 3)
- Original search date (from search log)
- Original included studies list (from Phase 4)
- Publication status of original review
Workflow
Step 1: Triage — Is an Update Needed?
ASK:
- "When was your original search run?"
- "Has the review been published? If so, what did the conclusions say?"
- "Have there been any major new trials or practice-changing developments in this area?"
Decision rules for update:
- <6 months old: "Your search is still current. No update needed. Set up an alert for quarterly checks."
- 6-12 months old: "Consider updating before submission/publication. Many journals expect searches within 12 months of submission."
- 12-24 months old: "An update is recommended. New evidence likely exists."
- >24 months old: "Your review is likely outdated. A full update is strongly recommended."
Step 2: Search Update
RE-RUN the original search with a date filter:
PubMed: Append to the original string:
AND ("2023/01/01"[Date - Publication] : "3000"[Date - Publication])
Replace the start date with the original search date + 1 day.
Run the search:
QUERY="(original string) AND (\"2023/01/01\"[Date - Publication] : \"3000\"[Date - Publication])"
python3 -c "
import urllib.parse, json, urllib.request
q = urllib.parse.quote('''$QUERY''')
url = f'https://eutils.ncbi.nlm.nih.gov/entrez/eutils/esearch.fcgi?db=pubmed&term={q}&retmax=0&retmode=json'
resp = urllib.request.urlopen(url)
data = json.load(resp)
print(f'New records since last search: {data[\"esearchresult\"][\"count\"]}')
"
Repeat for other databases as feasible.
Step 3: Screening Update
PROTOCOL:
- Screen ONLY new records (those published after the original search date)
- Follow the same eligibility criteria and process as the original review
- Use the same screening form and kappa targets
- Dual screening still required
Step 4: Decide on Update Type
| Situation | Recommended Update Type | |-----------|----------------------| | 0-2 new studies, conclusions unchanged | Brief update: Add to existing analysis, note in discussion | | 3-10 new studies, conclusions unchanged | Minor update: Re-run meta-analysis, update manuscript | | Any new studies, conclusions change | Major update: Full re-analysis, may change recommendation | | New population or outcome evidence emerges | Scope expansion: Consider separate review or major update | | New methodology (e.g., new synthesis method) | Methodological update: Re-analyze existing data |
Step 5: Living Review Infrastructure
If the user wants to maintain a living review:
-
Set up PubMed auto-alerts: Instructions for My NCBI:
- Save the search string in PubMed
- Create an RSS feed or email alert
- Set to "weekly" or "monthly"
-
Quarterly surveillance protocol:
- Every 3 months: re-run date-limited search
- Screen new records (1 reviewer, 2nd for conflicts)
- If ≥1 new eligible study found → escalate to full update
- If no new studies → log "No new evidence found, review remains current"
-
When to publish an update:
- ≥3 new studies that could change the pooled estimate
- New large trial (>500 participants) that could change conclusions
- Methodological advance that improves precision
- Live within 2 years of original publication
Step 6: Update Protocol
For a formal update (publishable):
- Register update on PROSPERO (existing record can be updated)
- Follow Cochrane handbook update guidance (Chapter 4)
- Report per PRISMA 2020 update guidelines
- Distinguish between "updated review" and "new review" in title
Step 7: Reporting the Update
In the updated manuscript:
- Title: "[Title]: An Updated Systematic Review and Meta-Analysis"
- Methods: "We updated our search on [date] and identified [N] additional studies."
- Results: Report original + new studies combined. Label new studies in forest plot.
- Discussion: "Since our original review, [N] additional trials have been published, [strengthening/changing] the evidence."
Scripts
scripts/search_update.sh
#!/bin/bash
# Run a date-limited PubMed search update
# Usage: ./scripts/search_update.sh "original search string" "2023-01-01"
QUERY=$(python3 -c "import urllib.parse; print(urllib.parse.quote('($1) AND (\"$2\"[Date - Publication] : \"3000\"[Date - Publication])'))")
curl -s "https://eutils.ncbi.nlm.nih.gov/entrez/eutils/esearch.fcgi?db=pubmed&term=$QUERY&retmax=0&retmode=json" | python3 -c "import json,sys; d=json.load(sys.stdin); print(f'New records: {d[\"esearchresult\"][\"count\"]}')"
Outputs to Generate
sr-update-protocol.md— Plan for the review updatesr-new-evidence-log.md— Tracking new studies identifiedsr-search-alert-setup.md— Instructions for auto-alertssr-living-review-protocol.md— If maintaining a living review
Guardrails
- Do NOT claim an update if you only re-ran the search — An update must include screening, extraction, and synthesis of new evidence.
- Do NOT combine new and old studies without checking comparability — New studies may use different populations, interventions, or outcomes.
- Date filter is essential — Without it, you'll search the entire database again.
- Living reviews require infrastructure — "A living review requires a dedicated team, regular surveillance, and a commitment to timely updates. Be realistic about resources."
- Do NOT change eligibility criteria between versions — Use the SAME criteria. If you change them, it's a different review.
Edge Cases
| Situation | Response | |-----------|----------| | No new studies found | "No new evidence since the original search. Your review remains current. Consider setting up alerts and re-checking in 6 months." | | New studies contradict original findings | Flag prominently. Meta-analysis may show different results. Discuss reasons for discrepancy (different population, larger sample, longer follow-up). | | User published the review in a journal that doesn't allow updates | "Consider publishing the update as a separate 'rapid update' or letter to the editor. Or deposit the update on a preprint server." | | Cochrane review update | "Cochrane has specific update policies. Contact your Cochrane Review Group for guidance." | | Original data lost | "Without original data, you'll need to re-extract. This is a strong argument for data archiving." |
Handoff
This is the final phase. Once complete:
- Summarize: "Review update complete. [N] new studies added. Conclusions [unchanged/changed]."
- Final outputs: Updated manuscript + search log + evidence tracking log
- If living review: "Your living review infrastructure is in place. Next quarterly check: [date]."
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