Stage-wise algorithmic bias, its reporting, and relation to classical systematic review biases in AI-based automated screening in health sciences: A structured literature review

Algorithmic bias in systematic reviews that use automatic screening is a major challenge in the application of AI in health sciences. This article presents preliminary findings from the project titled “Identification, Reporting, and Mitigation of Algorithmic Bias in Systematic Reviews with AI-Assisted Screening: Systematic Review and Development of a Checklist for its Evaluation” registered in PROSPERO with the registration number CRD420251036600 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251036600). The results presented here are preliminary and part of ongoing work.

To synthesize knowledge about the taxonomies of algorithmic bias, reporting, relationships with classical biases, and use of visualizations in AI-supported systematic reviews in health sciences.

A specific literature review was conducted, focusing on systematic reviews, conceptual frameworks, and reporting standards for bias in AI in healthcare, as well as studies cataloguing detection and mitigation strategies, with an emphasis on taxonomies, transparency practices, and visual/illustrative tools.

A mature body of work describes stage-based taxonomies and mitigation methods for algorithmic bias in general clinical AI. Common improvements in reporting and transparency (e.g. CONSORT-AI, SPIRIT-AI) are described. However, there is a notable absence of direct application to AI-automated screening of systematic reviews or empirical analyses of the interactions of biases with classical biases at the review level. Visualization techniques, such as bias heatmaps and pipe diagrams, are available, but have not been adapted to review workflows.

There are fundamental methodologies to identify and mitigate algorithmic bias in AI in health, but significant gaps remain in the understanding and operationalization of these frameworks within AI-assisted systematic reviews. Future research should address this translational gap to ensure transparency, fairness, and methodological rigor in the synthesis of evidence. Competing Interest Statement The authors have declared no competing interest. Clinical Protocols https://www.crd.york.ac.uk/PROSPERO/view/CRD420251036600 Funding Statement This study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes bpardal{at}usal.es Data Availability All data produced in the present work are contained in the manuscript