Systematic Reviews Legacy Guide: Using PRISMA for Reporting

"PRISMA stands for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. It is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. The aim of the PRISMA Statement is to help authors improve the reporting of systematic reviews and meta-analyses. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram." (From prisma-statement.org )

PRISMA and Covidence:

Covidence will track numbers of citations screened at each stage and how many are ultimately included in the review. These numbers can be copy and pasted into a PRISMA diagram template. A step-by-step guide on creating a PRISMA diagram is shown below.

In PRISMA 2020, there are now expanded options depending on where you search and whether you are updating a review. Version 1 of PRISMA 2020 includes databases and clinical trial or preprint registers.  Version 2 includes additional sections for elaborating on your grey literature search, such as searches on websites or in citation lists.  Both versions are available for new and updated reviews from the Equator Network's PRISMA Flow Diagram page.

Templates for New Reviews

Step 1: Preparation To complete the the PRISMA diagram, save a copy of the diagram to use alongside your searches. It can be downloaded from the PRISMA website. 

Step 2: Doing the Database Search Run the search for each database individually, including ALL your search terms, any MeSH or other subject headings, truncation (like hemipleg*), and/or wildcards (like sul?ur). Apply all your limits (such as years of search, English language only, and so on). Once all search terms have been combined and you have applied all relevant limits, you should have a final number of records or articles for each database. Enter this information in the top left box of the PRISMA flow chart. You should add the total number of combined results from all databases (including duplicates) after the equal sign where it says Databases (n=). Many researchers also add notations in the box for the number of results from each database search, for example, Pubmed (n=335), Embase (n= 600), and so on.  If you search trial registers, such as ClinicalTrials.gov, CENTRAL, ICTRP, or others, you should enter that number after the equal sign in Registers (n=).

NOTE: Some citation managers automatically remove duplicates with each file you import.  Be sure to capture the number of articles from your database searches before any duplicates are removed.

Step 3: Remove All Duplicates To avoid reviewing duplicate articles, you need to remove any articles that appear more than once in your results. You may want to export the entire list of articles from each database to a citation manager such as EndNote, Sciwheel, Zotero, or Mendeley (including both citation and abstract in your file) and remove the duplicates there. If you are using Covidence for your review, you should also add the duplicate articles identified in Covidence to the citation manager number.  Enter the number of records removed as duplicates in the second box on your PRISMA template.  If you are using automation tools to help evaluate the relevance of citations in your results, you would also enter that number here.

NOTE: If you are using Covidence to screen your articles, you can copy the numbers from the PRISMA diagram in your Covidence review into the boxes mentioned below.  Covidence does not include the number of results from each database, so you will need to keep track of that  number yourself.

Step 4: Records Screened- Title/Abstract Screening The next step is to add the number of articles that you will screen. This should be the number of records identified minus the number from the duplicates removed box.

Step 5: Records Excluded- Title/Abstract Screening You will need to screen the titles and abstracts for articles which are relevant to your research question. Any articles that appear to help you provide an answer to your research question should be included. Record the number of articles excluded through title/abstract screening in the box to the right titled "Records excluded."  You can optionally add exclusion reasons at this level, but they are not required until full text screening.

Step 6: Reports Sought for Retrieval This is the number of articles you obtain in preparation for full text screening.  Subtract the number of excluded records (Step 5) from the total number screened (Step 4) and this will be your number sought for retrieval.

Step 7: Reports Not Retrieved List the number of articles for which you are unable to find the full text.  Remember to use Find@UNC and Interlibrary Loan to request articles to see if we can order them from other libraries before automatically excluding them.

Step 8: Reports Assessed for Eligibility- Full Text Screening  This should be the number of reports sought for retrieval (Step 6) minus the number of reports not retrieved (Step 7). Review the full text for these articles to assess their eligibility for inclusion in your systematic review. 

Step 9: Reports Excluded After reviewing all articles in the full-text screening stage for eligibility, enter the total number of articles you exclude in the box titled "Reports excluded," and then list your reasons for excluding the articles as well as the number of records excluded for each reason.  Examples include wrong setting, wrong patient population, wrong intervention, wrong dosage, etc.  You should only count an excluded article once in your list even if if meets multiple exclusion criteria.

Step 10: Included Studies The final step is to subtract the number of records excluded during the eligibility review of full-texts (Step 9) from the total number of articles reviewed for eligibility (Step 8). Enter this number in the box labeled "Studies included in review," combining numbers with your grey literature search results in this box if needed.  You have now completed your PRISMA flow diagram, unless you have also performed searches in non-database sources.

If you are updating an existing review, use one of these PRISMA 2020 Updated Review templates, which feature an additional box for the number of studies and reports of studies included in the previous search iterations.