PRISMA 2020 Guidelines: Complete Checklist for Systematic Reviews

Master the Updated PRISMA Standards for Your Systematic ReviewThe PRISMA 2020 statement represents the most significant update to systematic review reporting guidelines in over a decade. Whether you’re writing your first systematic review or updating your approach, understanding these guidelines is essential for publication success.This comprehensive guide walks you through every PRISMA 2020 requirement with practical examples and tips for implementation.

What is PRISMA?

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) is an evidence-based minimum set of items for reporting systematic reviews. Originally published in 2009, the 2020 update reflects advances in systematic review methodology and addresses limitations identified over the past decade.

Why PRISMA Matters

• Journal requirement: Most high-impact journals require PRISMA compliance
• Peer review: Reviewers use PRISMA to evaluate manuscript quality
• Transparency: Enables readers to assess review validity
• Reproducibility: Others can replicate your methods
• Citation impact: Well-reported reviews get cited more

PRISMA 2020: Key Changes from 2009

The 2020 update introduces several important changes:

New Requirements

• Protocol registration and deviations reporting
• Complete search strategy for at least one database
• Citation details for all included studies
• Template data collection forms
• Study-level bias assessment for each outcome
• Certainty of evidence assessment (e.g., GRADE)

Updated Flow Diagram

The new flow diagram separates:

• Database searches vs. other sources
• Records removed before screening (duplicates, automation)
• Records excluded at each stage with reasons

The Complete PRISMA 2020 Checklist

Title

Item 1: Identify the report as a systematic review (with or without meta-analysis).Example: “Effectiveness of telehealth interventions for diabetes management: A systematic review and meta-analysis”

Abstract

Item 2: Provide a structured summary including background, objectives, data sources, study eligibility criteria, participants, interventions, study appraisal and synthesis methods, results, limitations, conclusions, and registration.Tip: Use the journal’s structured abstract format. Include the PROSPERO registration number.

Introduction

Item 3 (Rationale): Describe the rationale for the review in the context of existing knowledge.Item 4 (Objectives): Provide an explicit statement of the objective(s) or question(s) the review addresses.Tip: Use the PICO framework (Population, Intervention, Comparator, Outcome) to structure your question.

Methods – Eligibility Criteria

Item 5: Specify the inclusion and exclusion criteria for the review and how studies were grouped for syntheses.Include:

• Study characteristics (design, setting, timeframe)
• Participant characteristics
• Intervention and comparator details
• Outcome measures
• Language and publication status

Methods – Information Sources

Item 6: Specify all databases, registers, websites, organizations, reference lists, and other sources searched. Specify the date of the last search.Minimum databases for medical reviews: MEDLINE, Embase, Cochrane CENTRAL

Methods – Search Strategy

Item 7: Present the full search strategy for at least one database, including filters and limits.New in 2020: Full strategy is now required in the main paper or supplementary materials—not just “available upon request.”

Methods – Selection Process

Item 8: Specify the methods used to decide whether a study met inclusion criteria, including how many reviewers screened each record and each report, whether they worked independently, and any automation tools used.Best practice: Two independent reviewers with a third to resolve disagreements.

Methods – Data Collection

Item 9: Specify methods for collecting data from reports, including how many reviewers collected data, whether independently, and processes for obtaining or confirming data.New in 2020: Describe pilot testing of data extraction forms.

Methods – Data Items

Item 10a: List and define all outcomes for which data were sought.Item 10b: List and define all other variables for which data were sought.

Methods – Study Risk of Bias

Item 11: Specify the methods used to assess risk of bias in included studies, including which domains were assessed, which tool(s) were used, and how many reviewers assessed each study.Recommended tools:

• RCTs: Cochrane Risk of Bias 2 (RoB 2)
• Non-randomized: ROBINS-I
• Observational: Newcastle-Ottawa Scale

Methods – Effect Measures

Item 12: Specify for each outcome the effect measure(s) (e.g., risk ratio, mean difference) used in the synthesis.

Methods – Synthesis Methods

Item 13a-f: Describe processes used to decide which studies were eligible for each synthesis, methods for data preparation, tabulation and visual display, methods for synthesis, methods to explore heterogeneity, and sensitivity analyses.Key details:

• Fixed vs. random effects model
• Heterogeneity measures (I², Q, tau²)
• Subgroup analyses planned
• Meta-regression if applicable

Methods – Reporting Bias

Item 14: Describe methods used to assess risk of bias due to missing results in a synthesis.Common approaches: Funnel plots, Egger’s test, trim-and-fill

Methods – Certainty Assessment

Item 15: Describe methods used to assess certainty in the body of evidence.New in 2020: This is now a required element. Use GRADE or similar framework.

Results – Study Selection

Item 16a: Describe results of the search and selection process using the PRISMA flow diagram.Item 16b: Cite studies that appeared to meet inclusion criteria but were excluded, with reasons.

Results – Study Characteristics

Item 17: Cite each included study and present its characteristics.Tip: Include a “Characteristics of included studies” table with PICO elements.

Results – Risk of Bias

Item 18: Present assessments of risk of bias for each included study.Format: Traffic light plots, summary tables, or risk of bias graphs

Results – Individual Studies

Item 19: Present all data for outcomes of interest including effect estimates and confidence intervals.

Results – Synthesis

Item 20a-d: Present results of all syntheses, including heterogeneity assessments, sensitivity analyses, and bias assessments.For meta-analyses: Include forest plots for primary outcomes.

Results – Certainty of Evidence

Item 22: Present assessments of certainty for each outcome.Format: Summary of Findings tables with GRADE ratings

Discussion

Item 23a (Findings): Provide general interpretation of results in context of other evidence.Item 23b (Limitations): Discuss limitations of the evidence and the review process.Item 23c (Implications): Discuss implications for practice, policy, and future research.

Other Information

Item 24a-c: Provide registration and protocol information, including any amendments.Item 25: Describe sources of financial or non-financial support.Item 26: Declare competing interests.Item 27: Report availability of data, code, and materials.

The PRISMA Flow Diagram (2020 Version)

The updated flow diagram includes:Identification:

• Records from databases (n = X)
• Records from registers (n = X)
• Records from other sources (n = X)
• Records removed before screening (duplicates, automation tools)

Screening:

• Records screened (n = X)
• Records excluded (n = X)
• Reports sought for retrieval (n = X)
• Reports not retrieved (n = X)

Eligibility:

• Reports assessed (n = X)
• Reports excluded with reasons (n = X for each reason)

Included:

• Studies included in review (n = X)
• Studies included in meta-analysis (n = X)

Common PRISMA Compliance Errors

Avoid these frequent mistakes:

1. Incomplete search strategy: Provide full strategy, not summary
2. Missing exclusion reasons: Report why full-text articles were excluded
3. No protocol registration: Register on PROSPERO before starting
4. Skipping certainty assessment: GRADE is now expected
5. Outdated flow diagram: Use 2020 template

Tools and Resources

• PRISMA Statement: prisma-statement.org
• PROSPERO: crd.york.ac.uk/prospero
• Flow Diagram Generator: Available at prisma-statement.org
• Checklist PDF: Download from PRISMA website

Get Expert Help

Ensuring PRISMA 2020 compliance requires attention to methodological detail throughout your review. Our team provides:

• Protocol development and PROSPERO registration
• PRISMA-compliant manuscript writing
• Flow diagram creation
• GRADE assessments
• Pre-submission compliance checks

Ready to start your PRISMA-compliant systematic review? Explore our systematic review services or contact us for a free consultation.]]>