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Creating a PRISMA flow diagram: PRISMA 2020

Created by health science librarians.

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What is PRISMA?

Which prisma 2020 flow diagram should i use, step-by-step: prisma 2020 flow diagram, using the covidence prisma diagram, documenting your grey literature search, updating a systematic review with prisma 2020, citing prisma 2020, for more information, prisma 2020 checklist.

  • PRISMA 2020 Checklist (.doc)
  • PRISMA 2020 Checklist (.pdf)
  • PRISMA 2020 Expanded Checklist

PRISMA 2020 Flow Diagram Templates

  • PRISMA 2020 V1- New Reviews with Databases and Registers only PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only
  • PRISMA 2020 V2 - New Reviews with Databases, Registers, and Other Sources PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources

The format of the PRISMA Step-By-Step was first developed by Glasgow Caledonian University https://www.gcu.ac.uk/library

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"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. We have focused on randomized trials, but PRISMA can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions. PRISMA may also be useful for critical appraisal of published systematic reviews, although it is not a quality assessment instrument to gauge the quality of a systematic review. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram ."

"The PRISMA Explanation and Elaboration document explains and illustrates the principles underlying the PRISMA Statement. It is strongly recommended that it be used in conjunction with the PRISMA Statement.

PRISMA is part of a broader effort, to improve the reporting of different types of health research, and in turn to improve the quality of research used in decision-making in healthcare."

From prisma-statement.org

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.  J Clin Epidemiol . 2009;62(10):e1-e34. doi:10.1016/j.jclinepi.2009.06.006

Page MJ, Moher D, Bossuyt P, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. doi:10.31222/osf.io/gwdhk.

Rethlefsen M, Kirtley S, Waffenschmidt S, et al. PRISMA-S: An Extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. doi:10.31219/osf.io/sfc38.

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

The PRISMA diagram for Databases and Registers follows the same format as the previous 2009 PRISMA diagram

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.

Records identified from databases or registers

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.

Records removed before screening: duplicates, automation tool exclusions, or other reasons

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.

Number of records screened in Title/Abstract level

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.

Records excluded after title & abstract 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.

Reports 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.

Reports not retrived

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. 

Reports assessed for eligibility

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.

Reports excluded, including reason for exclusion and number

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.

Studies included in review

To view the PRISMA diagram created after using Covidence to screen references for your review, click the PRISMA button on the main menu of your review in Covidence.

PRISMA button

If you listed your sources when importing citations , your PRISMA diagram will include the list of databases you used and the number of references from each.

List of databases with number of articles imported

If you imported references from a citation manager, your PRISMA diagram starts with duplicate removal.  To have a complete PRISMA diagram, you will need to add the number of results from each database you searched, as well as the number of additional sources you found. 

Once you have finished title/abstract and full text screening (and data extraction or quality assessment if applicable), click Download DOCX to download your flow diagram as a Word document, or click View as text to copy and paste the PRISMA data or into an editable template for PRISMA and fill in the numbers.

In the upper right corner of the PRISMA section of Covidence, click View as text to see the plain text version of your review's totals, or click Download DOCX to download a word document with your review's totals in it

There are many places articles can get lost in the review process.  Remember to make sure your PRISMA numbers add up correctly!

Records identified from websites, organizations, citation searching, or other methods

Step 6: Included Studies The final step is to subtract the number of excluded articles or records during the eligibility review of full-texts from the total number of articles reviewed for eligibility. Enter this number in the box labeled "Studies included in review," combining numbers with your database search results in this box if needed.  You have now completed your PRISMA flow diagram, which you can now include in the results section of your article or assignment.

PRISMA 2020 templates for updated reviews include a box for the number of studies and reports included in the previous version of the review.

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.

  • PRISMA 2020 flow diagram for updated systematic reviews- databases and registers only
  • PRISMA 2020 flow diagram for updated systematic reviews- databases, registers and other sources

When referring to PRISMA 2020, The Equator Network recommends using journal article citations (such as those in our For More Information box ) rather than referring to the PRISMA website. If you are not already using a journal article citation, they recommend that you cite one of the original publications of the PRISMA Statement or PRISMA Explanation and Elaboration .

Related HSL Guides

  • Systematic Reviews

Additional Readings

  • Page MJ, McKenzie JE, Bossuyt PM, et al. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement . J Clin Epidemiol. 2021;134:103-112.
  • Page MJ, Moher D, Bossuyt PM, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews . Bmj. 2021;372:n160.
  • Radua J. PRISMA 2020 - An updated checklist for systematic reviews and meta-analyses. Neurosci Biobehav Rev. 2021;124:324-325.
  • Sarkis-Onofre R, Catalá-López F, Aromataris E, Lockwood C. How to properly use the PRISMA Statement . Systematic reviews. 2021;10(1):117-117.
  • Sohrabi C, Franchi T, Mathew G, et al. PRISMA 2020 statement: What's new and the importance of reporting guidelines. Int J Surg. 2021;88:105918.
  • Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews . Int J Surg. 2021;88:105906.
  • Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021.
  • Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . Bmj. 2021;372:n71.
  • Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews . PLoS Med. 2021;18(3):e1003583.
  • Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . Syst Rev. 2021;10(1):89.
  • Last Updated: Sep 13, 2023 7:26 AM
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Literature Reviews: systematic searching at various levels

  • for assignments
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  • Search strategy template
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PRISMA Flow Diagram

  • Grey Literature
  • What is the PRISMA Flow Diagram?
  • How should I use it?
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  • PRISMA Links

The PRISMA Flow Diagram is a tool that can be used to record different stages of the literature search process--across multiple resources--and clearly show how a researcher went from, 'These are the databases I searched for my terms', to, 'These are the papers I'm going to talk about'.

PRISMA is not inflexible; it can be modified to suit the research needs of different people and, indeed, if you did a Google images search for the flow diagram you would see many different versions of the diagram being used. It's a good idea to have a look at a couple of those examples, and also to have a look at a couple of the articles on the PRISMA website to see how it has--and can--be used.

The PRISMA 2020 Statement was published in 2021. It consists of a  checklist  and a  flow diagram , and is intended to be accompanied by the PRISMA 2020 Explanation and Elaboration document.

In order to encourage dissemination of the PRISMA 2020 Statement, it has been published in several journals.

  • How to use the PRISMA Flow Diagram for literature reviews A PDF [3.81MB] of the PowerPoint used to create the video. Each slide that has notes has a callout icon on the top right of the page which can be toggled on or off to make the notes visible.

There is also a PowerPoint version of the document but the file size is too large to upload here.

If you would like a copy, please email the Academic Librarians' mailbox from your university account to ask for it to be sent to you.

This is an example of how you  could  fill in the PRISMA flow diagram when conducting a new review. It is not a hard and fast rule but it should give you an idea of how you can use it.

For more detailed information, please have a look at this article:

Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Glanville, J., Grimshaw, J.M., Hróbjartsson, A., Lalu, M.M., Li, T., Loder, E.W., Mayo-Wilson, E., McDonald, S., McGuinness, L.A., Stewart, L.A., Thomas, J., Tricco, A.C., Welch, V.A., Whiting,P. & Moher, D. (2021) 'The PRISMA 2020 statement: an updated guideline for reporting systematic reviews',  BMJ 372:(71). doi: 10.1136/bmj.n71 .

  • Example of PRISMA 2020 diagram This is an example of *one* of the PRISMA 2020 flow diagrams you can use when reporting on your research process. There is more than one form that you can use so for other forms and advice please look at the PRISMA website for full details.

Start using the flow diagram as you start searching the databases you've decided upon. 

Make sure that you record the number of results that you found per database (before removing any duplicates) as per the filled in example. You can also do a Google images search for the PRISMA flow diagram to see the different ways in which people have used them to express their search processes.

  • Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. PRISMA focuses on the reporting of reviews evaluating randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions.
  • Prisma Flow Diagram This link will take you to downloadable Word and PDF copies of the flow diagram. These are modifiable and act as a starting point for you to record the process you engaged in from first search to the papers you ultimately discuss in your work. more... less... Do an image search on the internet for the flow diagram and you will be able to see all the different ways that people have modified the diagram to suit their personal research needs.

You can access the various checklists via the Equator website and the articles explaining PRISMA and its various extensions are available via PubMed.

Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Glanville, J., Grimshaw, J.M., Hróbjartsson, A., Lalu, M.M., Li, T., Loder, E.W., Mayo-Wilson, E., McDonald, S., McGuinness, L.A., Stewart, L.A., Thomas, J., Tricco, A.C., Welch, V.A., Whiting, P., & Moher, D. (2021) ' The PRISMA 2020 statement: an updated guideline for reporting systematic reviews,'  BMJ .  Mar 29; 372:n71. doi: 10.1136/bmj.n71 .

Page, M.J., Moher, D., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Glanville, J., Grimshaw, J.M., Hróbjartsson, A., Lalu, M.M., Li, T., Loder, E.W., Mayo-Wilson, E., McDonald, S., McGuinness, L.A., Stewart, L.A., Thomas, J., Tricco, A.C., Welch, V.A., Whiting, P., & McKenzie, J.E. (2021)  'PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews',  BMJ, Mar 29; 372:n160. doi: 10.1136/bmj.n160 .

Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., Brennan, S.E., Chou, R., Glanville, J., Grimshaw, J.M., Hróbjartsson, A., Lalu, M.M., Li, T., Loder, E.W., Mayo-Wilson, E., McDonald, S., McGuinness, L.A., Stewart, L.A., Thomas, J., Tricco, A.C., Welch, V.A., Whiting, P., & Moher, D. (2021) ' The PRISMA 2020 statement: An updated guideline for reporting systematic reviews,'  Journal of Clinical Epidemiology, June; 134:178-189. doi: 10.1016/j.jclinepi.2021.03.001 . 

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  • PRISMA flow diagram generator

Resource link

  • PRISMA flow diagram templates

This tool, developed by PRISMA, can be used to develop a PRISMA flow diagram in order to report on systematic reviews.

The flow diagram depicts the flow of information through the different phases of a systematic review. It maps out the number of records identified, included and excluded, and the reasons for exclusions.

The aim of the PRISMA Statement is to help authors report a wide array of systematic reviews to assess the benefits and harms of a health care intervention. PRISMA focuses on ways in which authors can ensure the transparent and complete reporting of systematic reviews and meta-analyses.

We have adopted the definitions of systematic review and meta-analysis used by the Cochrane Collaboration [9]. A systematic review is a review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and analyse data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyse and summarise the results of the included studies. Meta-analysis refers to the use of statistical techniques in a systematic review to integrate the results of included studies.

PRISMA (n.d.). PRISMA Flow Diagram Generator . Retrieved from: https://estech.shinyapps.io/prisma_flowdiagram/

PRISMA (n.d.). PRISMA Flow Diagram Generator . Retrieved from: http://prisma-statement.org/PRISMAStatement/

'PRISMA flow diagram generator' is referenced in:

  • Systematic review

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prisma diagram for literature review template

Creating a PRISMA flow diagram

  • PRISMA-S Extension (PRISMA for Searching)
  • PRISMA-SCR Extension (PRISMA for Scoping Reviews)
  • PRISMA for Scoping Reviews Tips This link opens in a new window

Choosing a PRISMA Flow Diagram

Step-by-step: prisma 2020 flow diagram, documenting other sources, updating a systematic review with prisma 2020, citing prisma 2020.

  • Examples of Articles that use Prisma 2020
  • Removing Duplicates This link opens in a new window
  • EndNote 20 Assisting You in Research This link opens in a new window

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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 other sources that you have located, such as searches on websites (like Google Scholar) or in citation lists. Both versions are available for new and updated reviews from the Equator Network's  PRISMA Flow Diagram page .

prisma diagram for literature review template

To complete the the PRISMA diagram, save a copy of the diagram & checklist to use alongside your searches.  It can be downloaded from  the PRISMA website . I would recommend printing the diagram off and writing on it as you complete the PRISMA process. On the checklist, pay special attention to sections #6 to #8. In addition, before you begin your search you should read the PRISMA-S information & checklist.

In addition, you may find the following YouTube Video created by MD Anderson Research Library helpful. If you would like to use EndNote, here is a great video on how to integrate PRISMA with EndNote  (more information on Endnote can be found here ).

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 also keep track your searches using the PRISMA-S extension .   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, Medline with Fulltext (n=335), Cinahl Plus with Fulltext (n= 600), and so on. FYI Google Scholar should be documented following the next section about Documenting Other Sources . 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=) . You should also keep track of your searches using the PRISMA-S extension . Search strategies for all databases should be maintained on a document as they need to be reported in the final systematic/scoping review.

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.

Records identified from databases or registers

To avoid reviewing duplicate articles, you need to remove any articles that appear more than once in your results. I have created a page on how to Deduplicate your search results - read over this to learn how to do it. 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.  You can use Endnote to automatically deduplicate your results - For more information see this YouTube video from JCU Library .

Records removed before screening: duplicates, automation tool exclusions, or other reasons

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.  APU does not have a subscription for this however you can sign up for a free trial here . 

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.

Number of records screened in Title/Abstract level

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.

Records excluded after title & abstract screening

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.

Reports sought for retrieval

List the number of articles for which you are unable to find the full text.  Remember to use Article Finder  & Interlibrary Loan to locate articles in which we have a subscription and   to request articles from other libraries before automatically excluding them.

Reports not retrived

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 paper. 

Reports assessed for eligibility

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.

Reports excluded, including reason for exclusion and number

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 sources from other methods 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. 

Reports of included studies: " Authors might identify a study that has results appearing in two reports (for example one providing data at three months, another at two years follow-up). In this case, the number of studies included in the review is one , whereas the number of reports of included studies is two. This distinction was introduced in the PRISMA 2020 flow diagram based on our observation that the jump from the number of  reports  assessed for eligibility to the number of  studies  included in the review (as was prompted in the original PRISMA flow diagram) sometimes resulted in some reports not being accounted for. For example, we have seen some flow diagrams where the authors report assessing fifty full-text  reports  for eligibility, excluding forty  reports , and including eight  studies  (failing to indicate that two of the eight studies were published in two reports)" ( Rethlefsen & Page, 2021 ).

Studies included in review

If you have also searched additional sources, such as professional organization websites, cited or citing references, etc., complete the additional steps listed in the following "Documenting Other Sources" .

This tool allows you to produce a flow diagram for your own review that conforms to  the PRISMA2020 Statement.  You can provide the numbers in the data entry section of the  'Create flow diagram'  tab (click on the button at the top of the page).  

It also allows you to download an interactive HTML, PDF, PNG version of the plot, alongside several other common formats.

Automatically generate your diagram using the  ShinyApps Prisma Flow Diagram

Please remember to cite the tool as:

Haddaway, N. R., Page, M. J., Pritchard, C. C., & McGuinness, L. A. (2022). PRISMA2020: An R package and Shiny app for producing PRISMA 2020-compliant flow diagrams, with interactivity for optimised digital transparency and Open Synthesis Campbell Systematic Reviews, 18, e1230.  https://doi.org/10.1002/cl2.1230

To document other sources search, download the flow diagram template

  • version 1  PRISMA 2020 flow diagram for  new  systematic reviews which included searches of databases, registers and other sources   or the
  • version 2  PRISMA 2020 flow diagram for  updated  systematic reviews which included searches of databases, registers and other sources . 

Complete the boxes documenting your database searches on the left side of the template as outlined in the previous box  Step-by-step: PRISMA 2020 Flow Diagram .  Complete the right side of the template, Identification of studies via other methods, using the steps below.

If you have identified articles through other sources than databases (such as manual searches through reference lists of articles you have found or search engines like Google Scholar), enter the total number of records from each source type in the box on the top right of the flow diagram.

Records identified from websites, organizations, citation searching, or other methods

This should be the total number of reports you obtain from other sources. 

Reports sought for retrieval

List the number of documents for which you are unable to find the full text.  Remember to use  Article Finder  and Interlibrary Loan to locate articles in which we have a subscription and   to request articles from other libraries before automatically excluding them.

Reports not retrieved

This should be the number of other source methods reports sought for retrieval (Step 2) minus the number of reports not retrieved (Step 3). Review the full text for these items to assess their eligibility for inclusion in your paper. 

Reports assessed for eligibility (full text)

After reviewing all items 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 item as well as the number of items excluded for each reason.  Examples include wrong setting, wrong patient population, wrong intervention, wrong dosage, etc.  You should only count an excluded item once in your list even if if meets multiple exclusion criteria.

Reports excluded, with reasons for exclusion and number

The final step is to subtract the number of excluded articles or records during the eligibility review of full-texts from the total number of articles reviewed for eligibility. Enter this number in the box labeled "Studies included in review," combining numbers with your database search results in this box if needed.  You have now completed your PRISMA flow diagram, which you can now include in the results section of your article or assignment. 

PRISMA 2020 templates for updated reviews include a box for the number of studies and reports included in the previous version of the review.

PRISMA 2020 flow diagram for updated systematic reviews- databases and registers only

PRISMA 2020 flow diagram for updated systematic reviews- databases, registers and other sources  

When referring to PRISMA 2020, The Equator Network recommends using journal article citations (such as those in our References below) rather than referring to the PRISMA website. If you are not already using a journal article citation, they recommend that you cite one of the original publications of the  PRISMA Statement  or  PRISMA Explanation and Elaboration .

  • The PRISMA 2020 statement: An updated guideline for reporting systematic reviews - Equator Network
  • Page MJ, McKenzie JE, Bossuyt PM, et al.  Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement . J Clin Epidemiol. 2021;134:103-112.
  • Page MJ, Moher D, Bossuyt PM, et al.  PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews . Bmj. 2021;372:n160.
  • Radua J. PRISMA 2020 - An updated checklist for systematic reviews and meta-analyses. Neurosci Biobehav Rev. 2021;124:324-325.
  • Sarkis-Onofre R, Catalá-López F, Aromataris E, Lockwood C.  How to properly use the PRISMA Statement . Systematic reviews. 2021;10(1):117-117.
  • Sohrabi C, Franchi T, Mathew G, et al. PRISMA 2020 statement: What's new and the importance of reporting guidelines. Int J Surg. 2021;88:105918.
  • Page MJ, McKenzie JE, Bossuyt PM, et al.  The PRISMA 2020 statement: An updated guideline for reporting systematic reviews . Int J Surg. 2021;88:105906.
  • Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021.
  • Page MJ, McKenzie JE, Bossuyt PM, et al.  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . Bmj. 2021;372:n71.
  • Page MJ, McKenzie JE, Bossuyt PM, et al.  The PRISMA 2020 statement: An updated guideline for reporting systematic reviews . PLoS Med. 2021;18(3):e1003583.
  • Page MJ, McKenzie JE, Bossuyt PM, et al.  The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . Syst Rev. 2021;10(1):89.
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Look at the 'check your progress' box at the bottom of this page to make sure you have completed all the steps for this stage of your search

Download these for your own use - the worked example shows you how to built your own PRISMA - download the blank PRISMA to use in your literature review. 

  • Example of a PRISMA
  • Blank PRISMA

The diagram below explains the steps you need work through to complete your PRISMA. At the top of the page there is a downloadable blank PRISMA you can use in your literature review as well as a worked example. 

  • PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews, Page et al. 2021.

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What Is a PRISMA Flow Diagram?

prisma diagram for literature review template

Automate every stage of your literature review to produce evidence-based research faster and more accurately.

The PRISMA Statement guidelines were designed to improve how systematic reviews and meta-analyses are reported. They consist of a 27-point PRISMA Systematic Review Checklist and a 4-stage flow diagram, both of which help promote transparency and organization in the systematic review process. The PRISMA flow diagram depicts how information flows through the different phases of the review. It maps out the number of records identified, included, and excluded, plus the reasons for exclusions.

Types of PRISMA Flow Diagrams

There are two main types of PRISMA flow diagrams, expanded from the previous version (the current one is for 2020). The first version includes databases and clinical trial or preprint registers. The second includes extra sections to elaborate on gray literature (eg, searches on websites or within citation lists).

Both types of PRISMA flow diagrams are available in template form from the PRISMA website. Choosing which one to use depends on the type of review (whether it is new or an update) and the sources used to identify studies. If you’re unsure, check out our recent PRISMA diagram example .

PRISMA 2020 Diagram, DistillerSR

Steps to Making a PRISMA Flow Diagram

The PRISMA flow diagram can be divided into 3 phases: identification, screening, and inclusions (and exclusions). Here’s a breakdown of the steps to completing it.

Prepare the Diagram

Get a PRISMA flow diagram template from the PRISMA website and save it alongside your searches.

Run Database Searches

Run a search for each database you’re using; include all of your search terms, subject headings, truncation, and/or wildcards, and apply the relevant limits. Once you do this, you should have a final number of records for each database, which you must enter in the top left box of your flow chart. You can also add notations in the box for the number of results you get from each database search.

Remove Duplicate Articles

Remove any articles that appear more than once in your results and enter the number of removed duplicates in the second box of the template.

Add Articles to Screen

Add the number of articles to be screened, which should be the number of identified records minus the removed duplicates.

Screen Articles to Exclude

Screen your articles to ensure you only include those that are relevant to your search questions. Any articles that are excluded should be counted and the number must be noted in the box titled “records excluded.” You can also add reasons for exclusion here, but that is optional.

Record Reports Sought for Retrieval

Reports sought for retrieval are those that you obtain in preparation for full-text screening. This will be the total number of articles to be screened minus the number of “records excluded.”

Record Reports Not Retrieved

List the number of articles for which you can’t find the full text after using the necessary tools and resources.

Assess Eligibility of Articles for Inclusion

The number of reports assessed for eligibility should be the number of reports sought for retrieval minus the number of reports not retrieved. In this step, review the full text of these articles to determine if they are eligible to be included in the systematic review.

Enter Total Number of Reports Excluded

After a review of all the articles in the full-text screening stage for eligibility, input the total number of articles from “reports excluded.” Make sure an article meets exclusion criteria before adding them here; you are obliged to explain why you made the exclusions (eg, wrong setting, wrong population, wrong intervention).

List the Studies Included in the Review

Both types of PRISMA flow diagrams are available in template form from the PRISMA website. Choosing which one to use depends on the type of review (whether it is new or an update) and the sources used to identify studies. If you’re unsure, check out our recent PRISMA diagram example.

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Introduction to PRISMA Tables

Check your understanding, introduction to a prisma table.

PRISMA stands for Preferred Reporting Instrument for Systematic Reviews and Meta-Analysis. It is intended to show the research process from search to abstract review to full text selection. Those reading an article should pay attention to inclusion and exclusion criteria, and how authors determined articles for inclusion in their final research.

From the PRISMA website: "PRISMA is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. PRISMA focuses on the reporting of reviews evaluating randomized trials, but can also be used as a basis for reporting systematic reviews of other types of research, particularly evaluations of interventions."

PRISMA Flow Diagram (PDF and downloadable Word doc)

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Examples of PRISMA Tables

prisma diagram for literature review template

Folkestad, T., Brurberg, K.G., Nordhuus, K.M. et al. Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis. Crit Care 24, 2 (2020). https://doi.org/10.1186/s13054-019-2710-4

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PRISMA Templates

Download these fillable templates to include the PRISMA Flow Diagram and Checklist in your systematic review.

What is PRISMA?

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 PRISMA statement consists of a 27-item checklist and a 4-phase flow diagram. These items have been adapted for use by students conducting systematic reviews as part of the course requirements for KIN 4400. 

For more information, consult the PRISMA Explanation and Elaboration document.

Why PRISMA?

PRISMA is the recognized standard for reporting evidence in systematic reviews and meta-analyses. The standards are endorsed by organizations and journals in the health sciences.

Benefits of using PRISMA

  • Demonstrate quality of the review
  • Allow readers to assess strengths and weaknesses
  • Permits replication of review methods
  • Structure and format the review using PRISMA headings

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Understanding a PRISMA Flow Diagram

flow diagram – Edanz Learning Lab

The flow diagram (also called flowchart or flow chart ) is typically the first figure in the results section of your systematic review . A PRISMA flow diagram visually depicts the reviewers’ process of finding published data on the topic and how they decided whether to include it in the review.

From a PRISMA diagram, the reader can quickly and easily see:

  • how many studies the review screened
  • how many were included
  • what exclusion criteria were used

Understanding how to use and apply these flow charts is key in helping others help themselves by reading your review.

What you’ll learn in this post

• What a PRISMA diagram is, and how it shows a 4-step flow of a systematic literature review.

• How to read a PRISMA diagram and build your own.

• Tips for each step along the SLR journal when following PRISMA.

• Where to get expert guidance with your systematic literature review, and get published faster!

The 4 stages of a PRISMA flow diagram

The work described in the flow diagram is divided into 4 stages:

  • Identifying the articles for review
  • Screening the articles for review
  • Deciding on the studies’ eligibility
  • Finalizing the list of studies to include in the systematic review

PRISMA flow diagram example

1. Identifying the articles

In the first stage, run the searches you designed through the abstract and citation databases you selected (e.g., PubMed , Scopus ). Note how many records the search returned.

You might also add records you identified from other sources, such as Google Scholar or the reference lists from relevant articles.

⚠️ Caution : Each database has specific guidelines on how to search for keywords of interest and how to combine keywords for an effective search. This means your search strategy may have to differ slightly between databases. For example, the search function in PubMed is very literal: if you search for the word “rat” in titles, you won’t receive titles with the word “rats”; you’ll only get “rat”.

After running the searches in the databases you selected and adding the records you identified from other sources, combine all the records returned from the searches into one citation management program. For this, you can use:

  • DistillerSR
  • or even good old Microsoft Excel or Google Sheets

Next, remove duplicate records. In Excel, for example, click on the “Data” tab and select “Remove Duplicates.” You’ll be asked to specify which identifier (column heading) to sort by.

It’s better to sort by identifiers such as PubMed’s PMID or the article’s digital object identifier (DOI), because they are unique identifiers.

Two articles may have the same title, so if you delete duplicates by title, you may accidentally lose an important and valid source. Note how many unique records you have left after removing duplicates.

2. Screening the articles

In the second stage, one investigator reads the title and abstract of each record. They’re looking to determine whether the article contains material that would be relevant or helpful to the systematic review. 

This is a simple “yes/no” choice.

If you determine that the article should be excluded, you must also note the reason for exclusion . Reasons are typically:

  • “review article with no original data”
  • “no control group”
  • “not relevant to the research question and outcomes”
  • “opinion piece”
  • “wrong population/setting/intervention”

Note the number of articles you excluded and the number of articles under each reason for exclusion.

In some cases, two investigators perform the title and abstract screening. They do not divide the workload between them! Each investigator screens every title and abstract , and then their decisions are compared.

If one decides to exclude an article that the other believes should be included, they can check the full text together to arrive at a mutual decision. They can also ask a third person (typically this is the project manager or principal investigator) to make a decision on including the study.

The review articles you exclude may contain references to useful research studies that were not returned in your original searches. In that case, you can add those “extra” studies to the number of your “additional records.”

⚠️ Caution :  Sometimes, there will be two reasons to exclude an article. Be careful to select the most appropriate reason. For example, in many flow diagrams, you’ll see the exclusion criterion “article not in English.” If your search returns an article in a language that you can’t read, ask yourself: Is the article relevant to the topic of the systematic review? If yes, then it’s correct to exclude with the reason “article not in [the languages you can read].” However, if the topic of the article is not relevant to your systematic review, then your reason for exclusion should be “not relevant to the research question and outcomes.”

3. Deciding on the studies’ eligibility

In the third stage, you take the articles remaining after the title and abstract screening and read their full texts. This is to determine whether these articles would help you to answer your research question.

Two investigators perform the full-text screening. Each one reads the full text of all articles and makes an “include/exclude” decision.

As in the title/abstract screening, in the full-text screening, you must note the number of articles you exclude and the number of articles under each reason for exclusion.

Again, disagreements between investigators regarding whether an article should be included/excluded are resolved by discussion or by asking a third investigator to read the article and make a decision.

4. Finalizing the list of studies to include in the systematic review

After excluding irrelevant studies in the full-text screen, you’ll know how many studies will be included in your systematic review . Note this number in your flow diagram. 

In this fourth and last stage of screening, you determine how many of these studies can be included in a quantitative synthesis, also called a meta-analysis .

Not all studies that are eligible for the systematic review may be eligible for the meta-analysis. This is a statistical analysis that pools the data from multiple studies to test a hypothesis; not all studies will contain the data necessary for the quantitative synthesis.

Note the number of studies for the meta-analysis in the last (bottom) box of the flow diagram.

Go with the flow (chart): Here’s where to learn more

Flow diagrams are easy to graph using software such as Microsoft PowerPoint, Excel, and Visio. You can also find free flow diagram generators online.

To learn more about systematic literature reviews and how to conduct and report them, check the huge array of self-study co urses at Edanz Learning Lab . Many are free!

Log in or Create a Free Account to view this interactive dissection of a real systematic review, including flow charts

prisma diagram for literature review template

Dr. Dean Meyer is a Board-certified Editor in the Life Sciences (ELS). She has a background in environmental science with a specialist interest in toxicology and public health. Her doctoral research work focused on molecular mechanisms of metal detoxification in an invertebrate model. Her other research interests include the mechanisms of toxicity and disease causation, and the occupational sources of xenobiotics and their physiological effects.

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Writing Your Review

When writing up your systematic review keep in mind the specific guidelines for structuring your review. Systematic review standards are elements that should be reported in any published systematic review. Also there may be other 'Instructions to Authors' provided by the journals or organisations in which you plan to publish.

The PRISMA statement can be followed to ensure reliable coverage of the systematic review methods, results and conclusions. The PRISMA Elaboration and Explanation (E&E) document that accompanies the PRISMA statement provides instructions for each of the items on the checklist.

  • PRISMA Statement
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  • RV2 Checklist To help make informed decisions before publishing, MQ has developed the RV2 checklist to assist with selecting appropriate peer-reviewed journals.
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This link is to best practice examples from Cochrane on how to write about your searches in a Cochrane review.

You can adapt examples to suit your systematic review.

  • Search Text Templates for Reviews and Updates

Further reading

  • Article: Choosing the right journal for your systematic review
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  • Open access
  • Published: 29 March 2021

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

  • Matthew J. Page   ORCID: orcid.org/0000-0002-4242-7526 1 ,
  • Joanne E. McKenzie 1 ,
  • Patrick M. Bossuyt 2 ,
  • Isabelle Boutron 3 ,
  • Tammy C. Hoffmann 4 ,
  • Cynthia D. Mulrow 5 ,
  • Larissa Shamseer 6 ,
  • Jennifer M. Tetzlaff 7 ,
  • Elie A. Akl 8 ,
  • Sue E. Brennan 1 ,
  • Roger Chou 9 ,
  • Julie Glanville 10 ,
  • Jeremy M. Grimshaw 11 ,
  • Asbjørn Hróbjartsson 12 ,
  • Manoj M. Lalu 13 ,
  • Tianjing Li 14 ,
  • Elizabeth W. Loder 15 ,
  • Evan Mayo-Wilson 16 ,
  • Steve McDonald 1 ,
  • Luke A. McGuinness 17 ,
  • Lesley A. Stewart 18 ,
  • James Thomas 19 ,
  • Andrea C. Tricco 20 ,
  • Vivian A. Welch 21 ,
  • Penny Whiting 17 &
  • David Moher 22  

Systematic Reviews volume  10 , Article number:  89 ( 2021 ) Cite this article

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An Editorial to this article was published on 19 April 2021

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews. In order to encourage its wide dissemination this article is freely accessible on BMJ, PLOS Medicine, Journal of Clinical Epidemiology and International Journal of Surgery journal websites.

Systematic reviews serve many critical roles. They can provide syntheses of the state of knowledge in a field, from which future research priorities can be identified; they can address questions that otherwise could not be answered by individual studies; they can identify problems in primary research that should be rectified in future studies; and they can generate or evaluate theories about how or why phenomena occur. Systematic reviews therefore generate various types of knowledge for different users of reviews (such as patients, healthcare providers, researchers, and policy makers) [ 1 , 2 ]. To ensure a systematic review is valuable to users, authors should prepare a transparent, complete, and accurate account of why the review was done, what they did (such as how studies were identified and selected) and what they found (such as characteristics of contributing studies and results of meta-analyses). Up-to-date reporting guidance facilitates authors achieving this [ 3 ].

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement published in 2009 (hereafter referred to as PRISMA 2009) [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ] is a reporting guideline designed to address poor reporting of systematic reviews [ 11 ]. The PRISMA 2009 statement comprised a checklist of 27 items recommended for reporting in systematic reviews and an “explanation and elaboration” paper [ 12 , 13 , 14 , 15 , 16 ] providing additional reporting guidance for each item, along with exemplars of reporting. The recommendations have been widely endorsed and adopted, as evidenced by its co-publication in multiple journals, citation in over 60,000 reports (Scopus, August 2020), endorsement from almost 200 journals and systematic review organisations, and adoption in various disciplines. Evidence from observational studies suggests that use of the PRISMA 2009 statement is associated with more complete reporting of systematic reviews [ 17 , 18 , 19 , 20 ], although more could be done to improve adherence to the guideline [ 21 ].

Many innovations in the conduct of systematic reviews have occurred since publication of the PRISMA 2009 statement. For example, technological advances have enabled the use of natural language processing and machine learning to identify relevant evidence [ 22 , 23 , 24 ], methods have been proposed to synthesise and present findings when meta-analysis is not possible or appropriate [ 25 , 26 , 27 ], and new methods have been developed to assess the risk of bias in results of included studies [ 28 , 29 ]. Evidence on sources of bias in systematic reviews has accrued, culminating in the development of new tools to appraise the conduct of systematic reviews [ 30 , 31 ]. Terminology used to describe particular review processes has also evolved, as in the shift from assessing “quality” to assessing “certainty” in the body of evidence [ 32 ]. In addition, the publishing landscape has transformed, with multiple avenues now available for registering and disseminating systematic review protocols [ 33 , 34 ], disseminating reports of systematic reviews, and sharing data and materials, such as preprint servers and publicly accessible repositories. To capture these advances in the reporting of systematic reviews necessitated an update to the PRISMA 2009 statement.

Development of PRISMA 2020

A complete description of the methods used to develop PRISMA 2020 is available elsewhere [ 35 ]. We identified PRISMA 2009 items that were often reported incompletely by examining the results of studies investigating the transparency of reporting of published reviews [ 17 , 21 , 36 , 37 ]. We identified possible modifications to the PRISMA 2009 statement by reviewing 60 documents providing reporting guidance for systematic reviews (including reporting guidelines, handbooks, tools, and meta-research studies) [ 38 ]. These reviews of the literature were used to inform the content of a survey with suggested possible modifications to the 27 items in PRISMA 2009 and possible additional items. Respondents were asked whether they believed we should keep each PRISMA 2009 item as is, modify it, or remove it, and whether we should add each additional item. Systematic review methodologists and journal editors were invited to complete the online survey (110 of 220 invited responded). We discussed proposed content and wording of the PRISMA 2020 statement, as informed by the review and survey results, at a 21-member, two-day, in-person meeting in September 2018 in Edinburgh, Scotland. Throughout 2019 and 2020, we circulated an initial draft and five revisions of the checklist and explanation and elaboration paper to co-authors for feedback. In April 2020, we invited 22 systematic reviewers who had expressed interest in providing feedback on the PRISMA 2020 checklist to share their views (via an online survey) on the layout and terminology used in a preliminary version of the checklist. Feedback was received from 15 individuals and considered by the first author, and any revisions deemed necessary were incorporated before the final version was approved and endorsed by all co-authors.

The PRISMA 2020 statement

Scope of the guideline.

The PRISMA 2020 statement has been designed primarily for systematic reviews of studies that evaluate the effects of health interventions, irrespective of the design of the included studies. However, the checklist items are applicable to reports of systematic reviews evaluating other interventions (such as social or educational interventions), and many items are applicable to systematic reviews with objectives other than evaluating interventions (such as evaluating aetiology, prevalence, or prognosis). PRISMA 2020 is intended for use in systematic reviews that include synthesis (such as pairwise meta-analysis or other statistical synthesis methods) or do not include synthesis (for example, because only one eligible study is identified). The PRISMA 2020 items are relevant for mixed-methods systematic reviews (which include quantitative and qualitative studies), but reporting guidelines addressing the presentation and synthesis of qualitative data should also be consulted [ 39 , 40 ]. PRISMA 2020 can be used for original systematic reviews, updated systematic reviews, or continually updated (“living”) systematic reviews. However, for updated and living systematic reviews, there may be some additional considerations that need to be addressed. Where there is relevant content from other reporting guidelines, we reference these guidelines within the items in the explanation and elaboration paper [ 41 ] (such as PRISMA-Search [ 42 ] in items 6 and 7, Synthesis without meta-analysis (SWiM) reporting guideline [ 27 ] in item 13d). Box 1 includes a glossary of terms used throughout the PRISMA 2020 statement.

PRISMA 2020 is not intended to guide systematic review conduct, for which comprehensive resources are available [ 43 , 44 , 45 , 46 ]. However, familiarity with PRISMA 2020 is useful when planning and conducting systematic reviews to ensure that all recommended information is captured. PRISMA 2020 should not be used to assess the conduct or methodological quality of systematic reviews; other tools exist for this purpose [ 30 , 31 ]. Furthermore, PRISMA 2020 is not intended to inform the reporting of systematic review protocols, for which a separate statement is available (PRISMA for Protocols (PRISMA-P) 2015 statement [ 47 , 48 ]). Finally, extensions to the PRISMA 2009 statement have been developed to guide reporting of network meta-analyses [ 49 ], meta-analyses of individual participant data [ 50 ], systematic reviews of harms [ 51 ], systematic reviews of diagnostic test accuracy studies [ 52 ], and scoping reviews [ 53 ]; for these types of reviews we recommend authors report their review in accordance with the recommendations in PRISMA 2020 along with the guidance specific to the extension.

How to use PRISMA 2020

The PRISMA 2020 statement (including the checklists, explanation and elaboration, and flow diagram) replaces the PRISMA 2009 statement, which should no longer be used. Box  2 summarises noteworthy changes from the PRISMA 2009 statement. The PRISMA 2020 checklist includes seven sections with 27 items, some of which include sub-items (Table  1 ). A checklist for journal and conference abstracts for systematic reviews is included in PRISMA 2020. This abstract checklist is an update of the 2013 PRISMA for Abstracts statement [ 54 ], reflecting new and modified content in PRISMA 2020 (Table  2 ). A template PRISMA flow diagram is provided, which can be modified depending on whether the systematic review is original or updated (Fig.  1 ).

figure 1

 PRISMA 2020 flow diagram template for systematic reviews. The new design is adapted from flow diagrams proposed by Boers [ 55 ], Mayo-Wilson et al. [ 56 ] and Stovold et al. [ 57 ] The boxes in grey should only be completed if applicable; otherwise they should be removed from the flow diagram. Note that a “report” could be a journal article, preprint, conference abstract, study register entry, clinical study report, dissertation, unpublished manuscript, government report or any other document providing relevant information

We recommend authors refer to PRISMA 2020 early in the writing process, because prospective consideration of the items may help to ensure that all the items are addressed. To help keep track of which items have been reported, the PRISMA statement website ( http://www.prisma-statement.org/ ) includes fillable templates of the checklists to download and complete (also available in Additional file 1 ). We have also created a web application that allows users to complete the checklist via a user-friendly interface [ 58 ] (available at https://prisma.shinyapps.io/checklist/ and adapted from the Transparency Checklist app [ 59 ]). The completed checklist can be exported to Word or PDF. Editable templates of the flow diagram can also be downloaded from the PRISMA statement website.

We have prepared an updated explanation and elaboration paper, in which we explain why reporting of each item is recommended and present bullet points that detail the reporting recommendations (which we refer to as elements) [ 41 ]. The bullet-point structure is new to PRISMA 2020 and has been adopted to facilitate implementation of the guidance [ 60 , 61 ]. An expanded checklist, which comprises an abridged version of the elements presented in the explanation and elaboration paper, with references and some examples removed, is available in Additional file 2 . Consulting the explanation and elaboration paper is recommended if further clarity or information is required.

Journals and publishers might impose word and section limits, and limits on the number of tables and figures allowed in the main report. In such cases, if the relevant information for some items already appears in a publicly accessible review protocol, referring to the protocol may suffice. Alternatively, placing detailed descriptions of the methods used or additional results (such as for less critical outcomes) in supplementary files is recommended. Ideally, supplementary files should be deposited to a general-purpose or institutional open-access repository that provides free and permanent access to the material (such as Open Science Framework, Dryad, figshare). A reference or link to the additional information should be included in the main report. Finally, although PRISMA 2020 provides a template for where information might be located, the suggested location should not be seen as prescriptive; the guiding principle is to ensure the information is reported.

Use of PRISMA 2020 has the potential to benefit many stakeholders. Complete reporting allows readers to assess the appropriateness of the methods, and therefore the trustworthiness of the findings. Presenting and summarising characteristics of studies contributing to a synthesis allows healthcare providers and policy makers to evaluate the applicability of the findings to their setting. Describing the certainty in the body of evidence for an outcome and the implications of findings should help policy makers, managers, and other decision makers formulate appropriate recommendations for practice or policy. Complete reporting of all PRISMA 2020 items also facilitates replication and review updates, as well as inclusion of systematic reviews in overviews (of systematic reviews) and guidelines, so teams can leverage work that is already done and decrease research waste [ 36 , 62 , 63 ].

We updated the PRISMA 2009 statement by adapting the EQUATOR Network’s guidance for developing health research reporting guidelines [ 64 ]. We evaluated the reporting completeness of published systematic reviews [ 17 , 21 , 36 , 37 ], reviewed the items included in other documents providing guidance for systematic reviews [ 38 ], surveyed systematic review methodologists and journal editors for their views on how to revise the original PRISMA statement [ 35 ], discussed the findings at an in-person meeting, and prepared this document through an iterative process. Our recommendations are informed by the reviews and survey conducted before the in-person meeting, theoretical considerations about which items facilitate replication and help users assess the risk of bias and applicability of systematic reviews, and co-authors’ experience with authoring and using systematic reviews.

Various strategies to increase the use of reporting guidelines and improve reporting have been proposed. They include educators introducing reporting guidelines into graduate curricula to promote good reporting habits of early career scientists [ 65 ]; journal editors and regulators endorsing use of reporting guidelines [ 18 ]; peer reviewers evaluating adherence to reporting guidelines [ 61 , 66 ]; journals requiring authors to indicate where in their manuscript they have adhered to each reporting item [ 67 ]; and authors using online writing tools that prompt complete reporting at the writing stage [ 60 ]. Multi-pronged interventions, where more than one of these strategies are combined, may be more effective (such as completion of checklists coupled with editorial checks) [ 68 ]. However, of 31 interventions proposed to increase adherence to reporting guidelines, the effects of only 11 have been evaluated, mostly in observational studies at high risk of bias due to confounding [ 69 ]. It is therefore unclear which strategies should be used. Future research might explore barriers and facilitators to the use of PRISMA 2020 by authors, editors, and peer reviewers, designing interventions that address the identified barriers, and evaluating those interventions using randomised trials. To inform possible revisions to the guideline, it would also be valuable to conduct think-aloud studies [ 70 ] to understand how systematic reviewers interpret the items, and reliability studies to identify items where there is varied interpretation of the items.

We encourage readers to submit evidence that informs any of the recommendations in PRISMA 2020 (via the PRISMA statement website: http://www.prisma-statement.org/ ). To enhance accessibility of PRISMA 2020, several translations of the guideline are under way (see available translations at the PRISMA statement website). We encourage journal editors and publishers to raise awareness of PRISMA 2020 (for example, by referring to it in journal “Instructions to authors”), endorsing its use, advising editors and peer reviewers to evaluate submitted systematic reviews against the PRISMA 2020 checklists, and making changes to journal policies to accommodate the new reporting recommendations. We recommend existing PRISMA extensions [ 47 , 49 , 50 , 51 , 52 , 53 , 71 , 72 ] be updated to reflect PRISMA 2020 and advise developers of new PRISMA extensions to use PRISMA 2020 as the foundation document.

We anticipate that the PRISMA 2020 statement will benefit authors, editors, and peer reviewers of systematic reviews, and different users of reviews, including guideline developers, policy makers, healthcare providers, patients, and other stakeholders. Ultimately, we hope that uptake of the guideline will lead to more transparent, complete, and accurate reporting of systematic reviews, thus facilitating evidence based decision making.

Box 1 Glossary of terms

Systematic review —A review that uses explicit, systematic methods to collate and synthesise findings of studies that address a clearly formulated question [ 43 ]

Statistical synthesis —The combination of quantitative results of two or more studies. This encompasses meta-analysis of effect estimates (described below) and other methods, such as combining P values, calculating the range and distribution of observed effects, and vote counting based on the direction of effect (see McKenzie and Brennan [ 25 ] for a description of each method)

Meta-analysis of effect estimates —A statistical technique used to synthesise results when study effect estimates and their variances are available, yielding a quantitative summary of results [ 25 ]

Outcome —An event or measurement collected for participants in a study (such as quality of life, mortality)

Result —The combination of a point estimate (such as a mean difference, risk ratio, or proportion) and a measure of its precision (such as a confidence/credible interval) for a particular outcome

Report —A document (paper or electronic) supplying information about a particular study. It could be a journal article, preprint, conference abstract, study register entry, clinical study report, dissertation, unpublished manuscript, government report, or any other document providing relevant information

Record —The title or abstract (or both) of a report indexed in a database or website (such as a title or abstract for an article indexed in Medline). Records that refer to the same report (such as the same journal article) are “duplicates”; however, records that refer to reports that are merely similar (such as a similar abstract submitted to two different conferences) should be considered unique.

Study —An investigation, such as a clinical trial, that includes a defined group of participants and one or more interventions and outcomes. A “study” might have multiple reports. For example, reports could include the protocol, statistical analysis plan, baseline characteristics, results for the primary outcome, results for harms, results for secondary outcomes, and results for additional mediator and moderator analyses

Box 2 Noteworthy changes to the PRISMA 2009 statement

• Inclusion of the abstract reporting checklist within PRISMA 2020 (see item #2 and Box 2 ).

• Movement of the ‘Protocol and registration’ item from the start of the Methods section of the checklist to a new Other section, with addition of a sub-item recommending authors describe amendments to information provided at registration or in the protocol (see item #24a-24c).

• Modification of the ‘Search’ item to recommend authors present full search strategies for all databases, registers and websites searched, not just at least one database (see item #7).

• Modification of the ‘Study selection’ item in the Methods section to emphasise the reporting of how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process (see item #8).

• Addition of a sub-item to the ‘Data items’ item recommending authors report how outcomes were defined, which results were sought, and methods for selecting a subset of results from included studies (see item #10a).

• Splitting of the ‘Synthesis of results’ item in the Methods section into six sub-items recommending authors describe: the processes used to decide which studies were eligible for each synthesis; any methods required to prepare the data for synthesis; any methods used to tabulate or visually display results of individual studies and syntheses; any methods used to synthesise results; any methods used to explore possible causes of heterogeneity among study results (such as subgroup analysis, meta-regression); and any sensitivity analyses used to assess robustness of the synthesised results (see item #13a-13f).

• Addition of a sub-item to the ‘Study selection’ item in the Results section recommending authors cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded (see item #16b).

• Splitting of the ‘Synthesis of results’ item in the Results section into four sub-items recommending authors: briefly summarise the characteristics and risk of bias among studies contributing to the synthesis; present results of all statistical syntheses conducted; present results of any investigations of possible causes of heterogeneity among study results; and present results of any sensitivity analyses (see item #20a-20d).

• Addition of new items recommending authors report methods for and results of an assessment of certainty (or confidence) in the body of evidence for an outcome (see items #15 and #22).

• Addition of a new item recommending authors declare any competing interests (see item #26).

• Addition of a new item recommending authors indicate whether data, analytic code and other materials used in the review are publicly available and if so, where they can be found (see item #27).

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Acknowledgements

We dedicate this paper to the late Douglas G Altman and Alessandro Liberati, whose contributions were fundamental to the development and implementation of the original PRISMA statement.

We thank the following contributors who completed the survey to inform discussions at the development meeting: Xavier Armoiry, Edoardo Aromataris, Ana Patricia Ayala, Ethan M Balk, Virginia Barbour, Elaine Beller, Jesse A Berlin, Lisa Bero, Zhao-Xiang Bian, Jean Joel Bigna, Ferrán Catalá-López, Anna Chaimani, Mike Clarke, Tammy Clifford, Ioana A Cristea, Miranda Cumpston, Sofia Dias, Corinna Dressler, Ivan D Florez, Joel J Gagnier, Chantelle Garritty, Long Ge, Davina Ghersi, Sean Grant, Gordon Guyatt, Neal R Haddaway, Julian PT Higgins, Sally Hopewell, Brian Hutton, Jamie J Kirkham, Jos Kleijnen, Julia Koricheva, Joey SW Kwong, Toby J Lasserson, Julia H Littell, Yoon K Loke, Malcolm R Macleod, Chris G Maher, Ana Marušic, Dimitris Mavridis, Jessie McGowan, Matthew DF McInnes, Philippa Middleton, Karel G Moons, Zachary Munn, Jane Noyes, Barbara Nußbaumer-Streit, Donald L Patrick, Tatiana Pereira-Cenci, Ba′ Pham, Bob Phillips, Dawid Pieper, Michelle Pollock, Daniel S Quintana, Drummond Rennie, Melissa L Rethlefsen, Hannah R Rothstein, Maroeska M Rovers, Rebecca Ryan, Georgia Salanti, Ian J Saldanha, Margaret Sampson, Nancy Santesso, Rafael Sarkis-Onofre, Jelena Savović, Christopher H Schmid, Kenneth F Schulz, Guido Schwarzer, Beverley J Shea, Paul G Shekelle, Farhad Shokraneh, Mark Simmonds, Nicole Skoetz, Sharon E Straus, Anneliese Synnot, Emily E Tanner-Smith, Brett D Thombs, Hilary Thomson, Alexander Tsertsvadze, Peter Tugwell, Tari Turner, Lesley Uttley, Jeffrey C Valentine, Matt Vassar, Areti Angeliki Veroniki, Meera Viswanathan, Cole Wayant, Paul Whaley, and Kehu Yang. We thank the following contributors who provided feedback on a preliminary version of the PRISMA 2020 checklist: Jo Abbott, Fionn Büttner, Patricia Correia-Santos, Victoria Freeman, Emily A Hennessy, Rakibul Islam, Amalia (Emily) Karahalios, Kasper Krommes, Andreas Lundh, Dafne Port Nascimento, Davina Robson, Catherine Schenck-Yglesias, Mary M Scott, Sarah Tanveer and Pavel Zhelnov. We thank Abigail H Goben, Melissa L Rethlefsen, Tanja Rombey, Anna Scott, and Farhad Shokraneh for their helpful comments on the preprints of the PRISMA 2020 papers. We thank Edoardo Aromataris, Stephanie Chang, Toby Lasserson and David Schriger for their helpful peer review comments on the PRISMA 2020 papers.

Provenance and peer review

Not commissioned; externally peer reviewed.

Patient and public involvement

Patients and the public were not involved in this methodological research. We plan to disseminate the research widely, including to community participants in evidence synthesis organisations.

There was no direct funding for this research. MJP is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200101618) and was previously supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship (1088535) during the conduct of this research. JEM is supported by an Australian NHMRC Career Development Fellowship (1143429). TCH is supported by an Australian NHMRC Senior Research Fellowship (1154607). JMT is supported by Evidence Partners Inc. JMG is supported by a Tier 1 Canada Research Chair in Health Knowledge Transfer and Uptake. MML is supported by The Ottawa Hospital Anaesthesia Alternate Funds Association and a Faculty of Medicine Junior Research Chair. TL is supported by funding from the National Eye Institute (UG1EY020522), National Institutes of Health, United States. LAM is supported by a National Institute for Health Research Doctoral Research Fellowship (DRF-2018-11-ST2–048). ACT is supported by a Tier 2 Canada Research Chair in Knowledge Synthesis. DM is supported in part by a University Research Chair, University of Ottawa. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

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School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

Matthew J. Page, Joanne E. McKenzie, Sue E. Brennan & Steve McDonald

Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands

Patrick M. Bossuyt

Université de Paris, Centre of Epidemiology and Statistics (CRESS), Inserm, F 75004, Paris, France

Isabelle Boutron

Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia

Tammy C. Hoffmann

Annals of Internal Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA

Cynthia D. Mulrow

Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada

Larissa Shamseer

Evidence Partners, Ottawa, Canada

Jennifer M. Tetzlaff

Clinical Research Institute, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada

Elie A. Akl

Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA

York Health Economics Consortium (YHEC Ltd), University of York, York, UK

Julie Glanville

Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada

Jeremy M. Grimshaw

Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, JB Winsløwsvej 9b, 3rd Floor, 5000 Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark

Asbjørn Hróbjartsson

Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada; Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Canada; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Canada

Manoj M. Lalu

Department of Ophthalmology, School of Medicine, University of Colorado Denver, Denver, Colorado, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

Tianjing Li

Division of Headache, Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA; Head of Research, The BMJ, London, UK

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Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA

Evan Mayo-Wilson

Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK

Luke A. McGuinness & Penny Whiting

Centre for Reviews and Dissemination, University of York, York, UK

Lesley A. Stewart

EPPI-Centre, UCL Social Research Institute, University College London, London, UK

James Thomas

Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada; Epidemiology Division of the Dalla Lana School of Public Health and the Institute of Health Management, Policy, and Evaluation, University of Toronto, Toronto, Canada; Queen’s Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen’s University, Kingston, Canada

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Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada

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Contributions

JEM and DM are joint senior authors. MJP, JEM, PMB, IB, TCH, CDM, LS, and DM conceived this paper and designed the literature review and survey conducted to inform the guideline content. MJP conducted the literature review, administered the survey and analysed the data for both. MJP prepared all materials for the development meeting. MJP and JEM presented proposals at the development meeting. All authors except for TCH, JMT, EAA, SEB, and LAM attended the development meeting. MJP and JEM took and consolidated notes from the development meeting. MJP and JEM led the drafting and editing of the article. JEM, PMB, IB, TCH, LS, JMT, EAA, SEB, RC, JG, AH, TL, EMW, SM, LAM, LAS, JT, ACT, PW, and DM drafted particular sections of the article. All authors were involved in revising the article critically for important intellectual content. All authors approved the final version of the article. MJP is the guarantor of this work. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Matthew J. Page .

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All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/conflicts-of-interest/ and declare: EL is head of research for the BMJ ; MJP is an editorial board member for PLOS Medicine ; ACT is an associate editor and MJP, TL, EMW, and DM are editorial board members for the Journal of Clinical Epidemiology ; DM and LAS were editors in chief, LS, JMT, and ACT are associate editors, and JG is an editorial board member for Systematic Reviews . None of these authors were involved in the peer review process or decision to publish. TCH has received personal fees from Elsevier outside the submitted work. EMW has received personal fees from the American Journal for Public Health , for which he is the editor for systematic reviews. VW is editor in chief of the Campbell Collaboration, which produces systematic reviews, and co-convenor of the Campbell and Cochrane equity methods group. DM is chair of the EQUATOR Network, IB is adjunct director of the French EQUATOR Centre and TCH is co-director of the Australasian EQUATOR Centre, which advocates for the use of reporting guidelines to improve the quality of reporting in research articles. JMT received salary from Evidence Partners, creator of DistillerSR software for systematic reviews; Evidence Partners was not involved in the design or outcomes of the statement, and the views expressed solely represent those of the author.

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Additional file 1..

PRISMA 2020 checklist.

Additional file 2.

PRISMA 2020 expanded checklist.

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Page, M.J., McKenzie, J.E., Bossuyt, P.M. et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev 10 , 89 (2021). https://doi.org/10.1186/s13643-021-01626-4

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  • PMC8804909.1 ; 2021 Mar 8
  • PMC8804909.2 ; 2021 Mar 18
  • ➤ PMC8804909.3; 2022 Jan 28

Tailored PRISMA 2020 flow diagrams for living systematic reviews: a methodological survey and a proposal

Lara a. kahale.

1 Cochrane Central Executive, Cochrane, London, St Albans House, 57-59 Haymarket, London, SW1Y 4QX, UK

Rayane Elkhoury

2 Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar

3 World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine–Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar

Ibrahim El Mikati

4 Clinical Research Institute, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon

Hector Pardo-Hernandez

5 CIBER Epidemiología y Salud Pública, Madrid, Av. de Monforte de Lemos, 5, 28029, Spain

6 Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute, Barcelona, C / Sant Quintí, 77-79 08041, Spain

Assem M. Khamis

7 Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, HU6 7RX, UK

Holger J. Schünemann

8 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada

9 Department of Medicine, McMaster University, Hamilton, Ontario, 1280 Main Street West 2C Area, Canada

Neal R. Haddaway

10 Stockholm Environment Institute, Stockholm, Linnégatan, 87D, Sweden

11 Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa

12 Leibniz Centre for Agricultural Landscape Research (ZALF), Eberswalder Str. 84, 15374, Müncheberg, Germany

Elie A. Akl

13 Department of Internal Medicine, American University of Beirut, Beirut, Riad El Solh 1107 2020, Lebanon

Associated Data

Underlying data.

All data underlying the results are available as part of the article and no additional source data are required.

Version Changes

Revised. amendments from version 2.

We have made the following edits from version 2 to version 3:

  • We updated the affiliations of co-authors LAK, REK, IM, and NH
  • We updated the search from July 2020 to April 2021, our sample now includes 76 LSRs (270 living publications) instead of 32 LSRs (108 living publications). Hence, we updated the methods sections of the abstract and main-text.
  • We updated the survey findings in table 1 (characteristics of the living publications), table 2 (reporting on study flow), and figure 1 (Summary of the four tailored PRISMA flow diagram approaches) with the analysis of the 76 LSRs (270 living publications). Hence, we updated our results sections of the abstract and main-text.
  • Our conclusions did not change
  • Our suggestions of approaches to documenting and reporting LSR study flow did not change.
  • We referenced under implications for practice a web-based App that can facilitate producing flow diagrams for LSRs using the four approaches suggested.
  • We discussed under implications for research our plans and in developing extension to the PRISMA 2020 statement for LSRs.
  • We did some copy-editing.

Peer Review Summary

Background : While the PRISMA flow diagram is widely used for reporting standard systematic reviews (SRs), it was not designed for capturing the results of continual searches for studies in living systematic reviews (LSRs). The objectives of this study are (1) to assess how published LSRs report on the flow of studies through the different phases of the review for the different updates; (2) to propose an approach to reporting on that flow.

Methods : For objective 1, we identified all LSRs published up to April 2021. We abstracted information regarding their general characteristics and how they reported on search results. For objective 2, we based our proposal for tailored PRISMA approaches on the findings from objective 1, as well as on our experience with conducting Cochrane LSRs.

Results: We identified 279 living publications relating to 76 LSRs. Of the 279 publications, 11% were protocols, 23% were base versions (i.e., the first version), 50% were partial updates (i.e., does not include all typical sections of an SR), and 16% were full updates (i.e., includes all typical sections of an SR). We identified six ways to reporting the study flow: base separately, each update separately (38%); numbers not reported (32%); latest update separately, all previous versions combined (20%); base separately, all updates combined (7%); latest update version only (3%); all versions combined (0%). We propose recording in detail the results of the searches to keep track of all identified records. For structuring the flow diagram, we propose using one of four approaches.

Conclusion: We identified six ways for reporting the study flow through the different phases of the review for the different update versions. We propose to document in detail the study flow for the different search updates and select one of our four tailored PRISMA diagram approaches to present that study flow.

Introduction

During the coronavirus disease 2019 (COVID-19) pandemic, health research has proliferated exponentially 1 . Systematic reviews are essential to synthesize the evidence and inform policy and practice. Given the pace of research publication, those reviews need to be kept up to date. Living systematic reviews (LSRs) are an emerging type of systematic review that involves the continual search of the literature and incorporation of relevant new evidence, soon after it becomes available 2 . While many evidence synthesis groups are engaged in conducting LSRs or living network meta-analyses, others have developed living databases or living maps, including resources specific for COVID-19 literature 3 – 17 .

An essential component of systematic reviews is to keep track of and report the number of records captured while searching the scientific literature and details of the selection process 18 . The PRISMA statement recommends the use of the PRISMA flow diagram to depict the flow of studies through the different phases of the systematic review 19 . While the PRISMA flow diagram is a widely used tool for reporting original systematic reviews, it was not designed to capture the results of continual searches typically used in LSRs. Hence, it’s unclear how authors of LSRs address the issue of presenting results of these continual searches.

The objectives of this study were (1) to assess how published LSRs report on the flow of studies through the different phases of the review for the different updates; and (2) to propose an approach to documenting and reporting on the flow of studies through the different phases of a LSR, for the different updates.

For objective 1, we collected relevant data as part of a larger methodological survey aiming to assess the methods of conduct and reporting of LSRs. We have described the details of that study in a previously published protocol 20 . Briefly, we identified all living reviews published up to April 2021 available from the following electronic databases: Medline , EMBASE and the Cochrane library (see extended data 21 of Khamis et al. 20 for the search strategy). An eligible living review was either (1) a protocol for an LSR, (2) a base version of an LSR, (3) a full update version of an LSR, (4) a partial update version of an LSR, or (5) a combination of any of these (e.g., one living review may constitute of a protocol, a base version, and a full update version; another living review may constitute of only a Box 1 the definition of each type of living reviews.

Box 1. Definition of the different publication types of living reviews

•  LSR protocol: the protocol that describes the planned methods of the living review

•  Base version: the first version of the review that follows a living approach

•  Full update version: a subsequent version of the review that includes all the typical sections of a systematic review, including an introduction, methods, and results sections. Such a version could stand-alone in terms of content.

•  Partial update version: a subsequent version of the review that does not include all the typical sections of a systematic review, but instead refers to a previous version for complementary information. Such a version could not stand-alone in terms of content.

For the current study, we abstracted information about the following features of LSRs:

  • Publication type, i.e., protocol, base version, full update version, partial update version.
  • Whether published in the Cochrane library or elsewhere.
  • Field (e.g., clinical, public health)
  • Whether COVID-19 related or not
  • Whether the base version of the living review conducted as a rapid review or not
  • ▪ Narrative format and/or flow diagram.
  • ▪ Whether the results of the base and update searches are reported separately or not.
  • Type of flow diagram, if applicable (e.g., PRISMA).

For objective 2, we base our proposal for tailored PRISMA 2020 flow diagram approaches on the findings from objective 1, on our experience conducting Cochrane LSRs, and our methodological work on designing and reporting living evidence. Since 2017, our group has been responsible for the first series of three Cochrane LSRs, all of which address anticoagulation in patients with cancer 22 – 24 . We conducted the base search in February 2016. Since then, we have been updating the search on a monthly basis. Through this experience, we have been able to apply and refine the guidance for conducting LSRs endorsed by the living evidence network group 25 . Specifically, we explored solutions for the reporting of the study flow that would address different scenarios. Our goal was not to be prescriptive and narrow, but rather to cover all possible resulting flows by reviewing the LSRs we identified based on objective 1. Two authors developed a draft of the tailored approaches to presenting the study flow, and then circulated to the author team for review and suggestions for improvement.

Data handling and analysis

We used REDCap to collect and manage the data abstraction process. All data were exported from REDCap and analyzed using Stata v. 13 26 , 27 .

Survey findings

Our search identified a total of 279 living publications relating to 76 LSRs. Table 1 shows their general characteristics. Of the 279 living publications, 11% were protocols, 23% were base versions, 50% were partial updates, and 16% were full updates. The median number of living publications per LSR was 2 (Interquartile range 1–4). Of the 76 living reviews, 22% were published in the Cochrane library, 63% were related to COVID-19, and 25% had a base version published as a rapid review. The majority were related to clinical topics (70%).

Abbreviations : LSR: living systematic review; IQR: interquartile range

Table 2 shows the results for the reporting on the study flow. Most base versions and full updates used a flow diagram to report on the search results (96% and 93% respectively), whereas only one partial update presented a flow diagram. In addition, none of the 279 living publications reported in their methods section how they plan to report on the study flow.

a When a flow diagram is not reported, the authors reported on the search results in a narrative format.

Among the 184 update versions ( Figure 1 ):

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Object name is f1000research-10-120090-g0000.jpg

  • 21% reported the search results for the base version and for each update version separately.
  • 11% reported on the search results for the base version separately and for all update versions combined
  • 13% reported the search results for the latest update version separately and for all previous versions combined (including the base).
  • 6% reported the search results for all the different versions combined.
  • 26% reported the search results for the latest update version only.
  • 23% did not report the search results at all (e.g., ‘new studies identified and integrated’ without specifying the number).

Proposed tailored PRISMA flow diagram approaches

Using the approach described in the methods section, we developed four approaches that allow authors to document and report the study flow for the different review update versions of an LSR.

1. Documenting LSR study flow

Authors should record in detail the results of the searches to keep track of all identified records. We propose using a spreadsheet for one LSR at a time. The format we present consists of tabs for each of the respective search sources: bibliographic databases (e.g. MEDLINE, EMBASE, Cochrane databases); conference proceedings; ongoing studies as captured in clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP); other tabs as needed, and a final ‘cumulative’ tab.

We show in Figure 2 a snapshot of the ‘cumulative’ tab of the spreadsheet that keeps track of all records. It shows the study flow for a hypothetical example for an LSR published first in January 2020 (i.e., base version) and updated on a monthly basis up to August 2020. Each row corresponds to a different update version. The columns present the following information for each update (columns B to E): the number of records received, deduplicated, included at title and abstract screening, and included at full-text screening (i.e., newly included reports). Additional columns (F to I) present the distribution of the newly included reports as relating to either: (1) new studies, (2) previously included studies, (3) ongoing (unpublished) studies, or (4) preprints.

An external file that holds a picture, illustration, etc.
Object name is f1000research-10-120090-g0001.jpg

After manually entering the information in the first five tabs (corresponding to the different search sources) the total is automatically computed in the ‘cumulative’ tab.

2. Reporting LSR study flow

The proposed spreadsheet can act as a basis for a tailored PRISMA flow diagram for LSRs. For structuring the flow diagram for LSR, one can select one out of four tailored PRISMA 2020 flow diagram approaches:

An external file that holds a picture, illustration, etc.
Object name is f1000research-10-120090-g0002.jpg

In our Cochrane reviews, we applied the second proposal where we present the results for the different searches combined.

This study found that authors of LSRs are not consistent in reporting on the flow of studies through the different phases of the review for the different update versions. Thus, we propose to document in detail the study flow for the different search updates and select one of four tailored PRISMA 2020 flow diagram approaches to present that study flow.

Strengths and limitations

To our knowledge, this is the first methodological survey that assesses how LSR authors report on the flow of studies through the different phases of the review for the different update versions of LSRs. In addition, the research expertise on our team covers both living approach and regular updating of traditional SR. We believe that our assessment forms a vital baseline and allows us to propose best practices for visualization options to improve consistency whilst the production of LSRs is still at a relatively early stage. Indeed, this survey is part of a larger methodological survey aiming to assess the methods of conduct and reporting of LSRs 20 , that would allow us to update our findings in the future.

Interpretation of findings

Authors tend to produce more partial updates of LSRs rather than continually updating the full systematic review. This might seem like a pragmatic approach particularly for a rapidly growing research field and when methods do not seem to change from one update to another. The heterogeneity observed in the ways LSR authors report on the study flow is likely to be explained by the lack of clear guidance on how to do so.

Implications for practice

We built our proposal on the PRISMA 2020 flow diagram and provide four approaches to tailor the needs for continual searchers used in LSR. The fourth approach is the closest to the current PRISMA 2020 flow diagram as it presents the results of the latest update version separately and the results of all previous versions (including the base) combined.

In addition, we proposed three other different approaches to provide options to LSR authors and publishing journals. Authors should choose one or the other approach based on the number of new citations, presentation preferences, and the impression of what provides the greatest transparency in reporting. Whatever approach one decides to follow, for transparency purposes, the systematic reviewers should ideally archive previous versions of the flow diagram (e.g., in an appendix). One major challenge will be to accommodate a large number of updates in the same diagram; some approaches would work better than others in that case. Also, advanced information technology solutions may allow fitting a large number of updates. A web-based prototype is available that allows readers to explore different reporting options across these four approaches: an R package ( https://github.com/nealhaddaway/livingPRISMAflow ) and web-based ShinyApp ( https://estech.shinyapps.io/livingprismaflow/ ) were developed that allow users to enter their own data (e.g., from the spreadsheet suggested above) to produce a bespoke flow diagram according to their desired approach or to create their own interactive diagram that allows readers to toggle between different versions of the same data 28 .

Advanced information technology can also be utilized to simplify updating and tracking the change in all LSR sections including the PRISMA diagram. It would be optimal to develop the base version in a certain platform where all SR and LSR sections are reported as units (i.e., title, authors, background, objectives, inclusion criteria, effect estimate for outcome x). With each update and for every unit, the author has the luxury to keep the same text (if no change has occurred) or edit (if change has occurred). Each unit can be updated in a differential speed based on certain criteria. The edits could be highlighted to visualize the change. For a certain section, one would easily have access to the entries in the previous versions and possibly visualize a trend across the different versions (i.e., cross-sectional view for that specific item). For example, dynamic documents can be developed using ‘R markdown’, a document preparation system, where static text can be combined with in-line code and ‘code chunks’ that produce instantly updatable documents given a modified input 29 .

Implications for future research

This study is part of a bigger project aiming to develop extension to the PRISMA 2020 statement for LSRs (please see registration form on EQUATOR network website: Equator Network. PRISMA for LSR – Extension of PRISMA 2020 for living systematic reviews . 2021; Accessed from https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-systematic-reviews/#LSR ]. This project will pilot the proposed approaches for documenting the study flow and for structuring the living flow diagram. In addition, qualitative studies would be helpful to explore: (1) the feasibility and acceptability by LSR authors, publishers, and users towards the proposal; and (2) what the end-users would like to see in an LSR update.

Conclusions

LSR authors are not consistent in reporting the flow of studies through the different phases of the review for the different update versions. We propose to document in detail the study flow for the different search updates. Authors can select one of our four tailored PRISMA 2020 flow diagram approaches to present that study flow until detailed guidance will become available. Improving the reporting of study flow in LSR methodology is essential for incorporating living evidence when developing living guidance, particularly in the context of an urgent response 30 , 31 .

Data availability

Acknowledgment.

We would like to acknowledge Dr. Mathew Page for his revision for the manuscript.

[version 3; peer review: 2 approved]

Funding Statement

The author(s) declared that no grants were involved in supporting this work.

Reviewer response for version 3

Lex m. bouter.

1 Department of Epidemiology and Data Science, Amsterdam Universities Medical Center, Amsterdam, The Netherlands

2 Department of Philosophy, Faculty of Humanities, Vrije Universiteit, Amsterdam, The Netherlands

I applaud the authors for updating their survey and for more than double the sample size. They also made some other - rather marginal -  changes and explain that their publication is only the first of a series based on an ongoing project.

Is the work clearly and accurately presented and does it cite the current literature?

If applicable, is the statistical analysis and its interpretation appropriate?

Are all the source data underlying the results available to ensure full reproducibility?

Is the study design appropriate and is the work technically sound?

Are the conclusions drawn adequately supported by the results?

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

Methodology, epidemiology, research integrity, open science, systematic review methods.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Reviewer response for version 2

Sonia hines.

1 College of Medicine and Public Health, Flinders University, Alice Springs, Northern Territory, Australia

This is an interesting proposal to solve the problem of study flow reporting in living systematic reviews (LSRs). As LSRs increase in number, the methodology and reporting requirements need to be well described and usable.

I am not sure these particular suggested approaches are the most practical. Spreadsheets are not easily inserted into publications, but it is a worthwhile question to be asking, and working from the existing publications is a good starting point.

The authors have done what they set out to do, but I suggest further work is needed before a recommended method of study flow reporting is settled upon.

Systematic reviews, evidence-based practice.

Lara Kahale

American University of Beirut, Lebanon

The Reviewers’ comments are in bold font and our replies in regular font. Extracts from the text are in italic fonts with changes underlined . We have indicated the sections where revisions have been made in our manuscript.

Reviewer 2: Sonia Hines

1. This is an interesting proposal to solve the problem of study flow reporting in living systematic reviews (LSRs). As LSRs increase in number, the methodology and reporting requirements need to be well described and usable. I am not sure these particular suggested approaches are the most practical. Spreadsheets are not easily inserted into publications, but it is a worthwhile question to be asking, and working from the existing publications is a good starting point.

  • Thank you for your positive feedback and practical advice. We agree that spreadsheets are not easily publishable, that is why we recommend using it as a tool for the LSR authors to document in detail the study flow as opposed to using it as a reporting tool. We now elaborate in the discussion how this spreadsheet would feed in an app (shinyapp) that creates nicely designed flows for these four approaches well suited for insertion into a publication.  

2. The authors have done what they set out to do, but I suggest further work is needed before a recommended method of study flow reporting is settled upon.

  • We agree with this comment. This study is a methodological survey aiming to summarize what LSR authors are currently reporting. As this is not a guidance document, we are not making any recommendations. However, this study is part of a bigger project aiming to develop extension to the PRISMA 2020 statement for LSRs. For that purpose, we will be following the EQUATOR Network’s guidance for developing health research reporting guidelines which include, but is not limited to, engaging stakeholders, including methodologists, LSR end-users, Cochrane groups, journal editors, etc. in a Delphi exercise. In addition, we will be doing a scoping review of current guidance documents and methods papers, and a qualitative study with stakeholders.

Living Systematic Reviews (LSRs) are updated as new evidence becomes available and gained popularity during the Covid-19 pandemic. This manuscript describes the way PRISMA 2020 flow diagrams are handled in 32 LSRs with a view to recommend how this can best be done. The topic is relevant albeit a bit narrow and the manuscript is written clearly. However, there’re some issues that should to be solved in the next version of the manuscript.

Major issues

  • It’s disappointing that no clear recommendation but four alternative recommendations are given without any guidance which one to select when. That sounds a bit like ‘anything goes’. The reduction from the six approaches found in the LSRs to date to the four recommended is not very impressive. I was also surprised that the recommendations were solely based on the experience of the authors. Why is no attempt made to consult survey methodologists and end-users of LSRs, e.g. by performing a Delphi study? Also Cochrane Methods Groups and the editors of the Cochrane Handbook seem not to have been approached with a request to state their view on the issue.
  • The findings presented are part of a larger project on the methods of LSRs about which near to nothing is said in the manuscript. That makes one wonder whether this is not too small a part of the harvest to be optimally useful. Please explain why this element on flow charts is separated from the rest.
  • The data set is quite small: 32 LSRs of which 8 are only available as study protocol, 12 have only one (base) version, and 12 have one or more updates. Why is no indication provided of the corresponding imprecision, e.g. by presenting 95% confidence intervals?
  • The bottom half of table 2 presents how the study flow is reported among the 12 LSRs that got at least one update. I recommend to do this for all 32 LSRs included, assuming that when no update is yet reported the envisioned handling of flow charts should be specified in either the review protocol or the base version of the review.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Reviewer 1: Lex Bouter

1. It’s disappointing that no clear recommendation but four alternative recommendations are given without any guidance which one to select when. That sounds a bit like ‘anything goes’. The reduction from the six approaches found in the LSRs to date to the four recommended is not very impressive. I was also surprised that the recommendations were solely based on the experience of the authors. Why is no attempt made to consult survey methodologists and end-users of LSRs, e.g. by performing a Delphi study? Also Cochrane Methods Groups and the editors of the Cochrane Handbook seem not to have been approached with a request to state their view on the issue.

  • Thank you for your comment. This study is a methodological survey aiming to summarize what current LSR authors are reporting. Given that the full methodology of living systematic reviews is still emerging, we prefer not to make firm recommendations but lay out options. However, this study is part of a bigger project aiming to develop extension to the PRISMA 2020 statement for LSRs (please see registration form on EQUATOR network website: Equator Network. PRISMA for LSR – Extension of PRISMA 2020 for living systematic reviews . 2021; Accessed from https:// www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-systematic-reviews/#LSR] ) . Consistently with the Reviewer’s suggestions, we will be following the EQUATOR Network’s guidance for developing health research reporting guidelines which include, but is not limited to, engaging stakeholders, including methodologists, LSR end-users, Cochrane groups, journal editors, etc. in Delphi exercise. In addition, we will be doing a scoping review of current guidance documents and methods papers, and a qualitative study with stakeholders. We have elaborated about this research under implications for future research.

2. The findings presented are part of a larger project on the methods of LSRs about which near to nothing is said in the manuscript. That makes one wonder whether this is not too small a part of the harvest to be optimally useful. Please explain why this element on flow charts is separated from the rest.

  • Thank you for your query. This paper is the first published study within the larger project which aims to explore how LSRs authors are currently reporting, conducting, and publishing LSRs. We cite the protocol of that project (Khamis 2019). This study focuses on reporting flow diagrams, another study will focus on general characteristics and delay in updating LSRs, and a third study will focus on methodological features of LSRs. We have now updated our results to include data from up to April 2021, and our dataset now includes 279 publications of 76 LSRs. 

3. The data set is quite small: 32 LSRs of which 8 are only available as study protocol, 12 have only one (base) version, and 12 have one or more updates. Why is no indication provided of the corresponding imprecision, e.g. by presenting 95% confidence intervals?

  • Thank you for your comment. Unfortunately, that was the state of the science. However, as noted in the previous comment, we have now updated our search to include results up to April 2021 Including data from 279 publications of 76 LSRs. We avoided including confidence intervals for the simplicity of presentation and given the small sample size. We are happy to include these if the editor prefers so.

4. The bottom half of table 2 presents how the study flow is reported among the 12 LSRs that got at least one update. I recommend to do this for all 32 LSRs included, assuming that when no update is yet reported the envisioned handling of flow charts should be specified in either the review protocol or the base version of the review .

  • Thank you for your suggestion. We have checked and found the following (now added to the text): ‘ None of the 279 living publications reported in their methods section how they plan to report on the study flow’ .

prisma diagram for literature review template

  • Exporting data

PRISMA flow diagram

The PRISMA flow diagram illustrates the flow of studies through the different stages of a systematic or other literature review. It provides details on the number of studies identified, included and excluded and the reasons for exclusion at full text review.

Covidence provides a template that now aligns with PRISMA 2020 for a systematic literature review.

Other information on PRISMA statements and extensions can be found on the PRISMA website .

Literature Reviews

  • Getting Started
  • Choosing a Type of Review
  • Developing a Research Question
  • Searching the Literature
  • Searching Tips
  • ChatGPT [beta]
  • Documenting your Search
  • Using Citation Managers
  • Concept Mapping
  • Concept Map Definition

MindMeister

  • Writing the Review
  • Further Resources

Additional Tools

Google slides.

GSlides can create concept maps using their Diagram feature. Insert > Diagram > Hierarchy will give you some editable templates to use.

Tutorial on diagrams in GSlides .

MICROSOFT WORD

MS Word can create concept maps using Insert > SmartArt Graphic. Select Process, Cycle, Hierarchy, or Relationship to see templates.

NVivo  is software for qualitative analysis that has a concept map feature. Zotero libraries can be uploaded using ris files. NVivo Concept Map information.

A concept map or mind map is a visual representation of knowledge that illustrates relationships between concepts or ideas. It is a tool for organizing and representing information in a hierarchical and interconnected manner. At its core, a concept map consists of nodes, which represent individual concepts or ideas, and links, which depict the relationships between these concepts .

Below is a non-exhaustive list of tools that can facilitate the creation of concept maps.

prisma diagram for literature review template

www.canva.com

Canva is a user-friendly graphic design platform that enables individuals to create visual content quickly and easily. It offers a diverse array of customizable templates, design elements, and tools, making it accessible to users with varying levels of design experience. 

Pros: comes with many pre-made concept map templates to get you started

Cons : not all features are available in the free version

Explore Canva concept map templates here .

Note: Although Canva advertises an "education" option, this is for K-12 only and does not apply to university users.

prisma diagram for literature review template

www.lucidchart.com

Lucid has two tools that can create mind maps (what they're called inside Lucid): Lucidchart is the place to build, document, and diagram, and Lucidspark is the place to ideate, connect, and plan.

Lucidchart is a collaborative online diagramming and visualization tool that allows users to create a wide range of diagrams, including flowcharts, org charts, wireframes, and mind maps. Its mind-mapping feature provides a structured framework for brainstorming ideas, organizing thoughts, and visualizing relationships between concepts. 

Lucidspark , works as a virtual whiteboard. Here, you can add sticky notes, develop ideas through freehand drawing, and collaborate with your teammates. Has only one template for mind mapping.

Explore Lucid mind map creation here .

How to create mind maps using LucidSpark: 

Note: U-M students have access to Lucid through ITS. [ info here ] Choose the "Login w Google" option, use your @umich.edu account, and access should happen automatically.

prisma diagram for literature review template

www.figma.com

Figma is a cloud-based design tool that enables collaborative interface design and prototyping. It's widely used by UI/UX designers to create, prototype, and iterate on digital designs. Figma is the main design tool, and FigJam is their virtual whiteboard:

Figma  is a comprehensive design tool that enables designers to create and prototype high-fidelity designs

FigJam focuses on collaboration and brainstorming, providing a virtual whiteboard-like experience, best for concept maps

Explore FigJam concept maps here .

prisma diagram for literature review template

Note: There is a " Figma for Education " version for students that will provide access. Choose the "Login w Google" option, use your @umich.edu account, and access should happen automatically.

prisma diagram for literature review template

www.mindmeister.com

MindMeister  is an online mind mapping tool that allows users to visually organize their thoughts, ideas, and information in a structured and hierarchical format. It provides a digital canvas where users can create and manipulate nodes representing concepts or topics, and connect them with lines to show relationships and associations.

Features : collaborative, permits multiple co-authors, and multiple export formats. The free version allows up to 3 mind maps.

Explore  MindMeister templates here .

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IMAGES

  1. PRISMA Diagram of Literature Review Process

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  2. PRISMA flow chart of literature review

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  3. systematic literature review and prisma

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  4. Understanding a PRISMA Flow Diagram

    prisma diagram for literature review template

  5. PRISMA flow diagram for systematic literature review.

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  6. PRISMA flow diagram for the systematic literature review

    prisma diagram for literature review template

VIDEO

  1. Literature Review Template for Thesis/Proposal

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COMMENTS

  1. Creating a PRISMA flow diagram: PRISMA 2020

    To document your grey literature search, download the flow diagram template version 1 PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, ... 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 ...

  2. PRISMA Flow Diagram

    The PRISMA Flow Diagram is a tool that can be used to record different stages of the literature search process--across multiple resources--and clearly show how a researcher went from, 'These are the databases I searched for my terms', to, 'These are the papers I'm going to talk about'.

  3. PRISMA flow diagram generator

    Resource link. This tool, developed by PRISMA, can be used to develop a PRISMA flow diagram in order to report on systematic reviews. The flow diagram depicts the flow of information through the different phases of a systematic review. It maps out the number of records identified, included and excluded, and the reasons for exclusions.

  4. The PRISMA 2020 statement: an updated guideline for reporting ...

    A template PRISMA flow diagram is provided, which can be modified depending on whether the systematic review is original or updated . Box 2 Noteworthy changes to the PRISMA 2009 statement. ... MJP conducted the literature review, administered the survey and analysed the data for both. MJP prepared all materials for the development meeting.

  5. STEP BY STEP: Using PRISMA2020

    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. PRISMA 2020 flow diagram for updated systematic reviews- databases and registers only

  6. PRISMA 2020 explanation and elaboration: updated guidance and exemplars

    PRISMA 2020 flow diagram template for systematic reviews (adapted from flow diagrams proposed by Boers 131 and Mayo-Wilson et al. 65 and Stovold et al. 132). The boxes in grey should only be completed if applicable; otherwise they should be removed from the flow diagram.

  7. Literature reviews: Health: PRISMA flowchart

    The diagram below explains the steps you need work through to complete your PRISMA. At the top of the page there is a downloadable blank PRISMA you can use in your literature review as well as a worked example. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews, Page et al. 2021.

  8. How to properly use the PRISMA Statement

    Thus, the following examples can illustrate the appropriate use of the PRISMA Statement in research reporting: "The reporting of this systematic review was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement.". "This scoping review was reported according to the Preferred ...

  9. What Is a PRISMA Flow Diagram

    The PRISMA Statement guidelines were designed to improve how systematic reviews and meta-analyses are reported. They consist of a 27-point PRISMA Systematic Review Checklist and a 4-stage flow diagram, both of which help promote transparency and organization in the systematic review process. The PRISMA flow diagram depicts how information flows through the different phases of the review.

  10. Creating a PRISMA Table

    PRISMA stands for Preferred Reporting Instrument for Systematic Reviews and Meta-Analysis. It is intended to show the research process from search to abstract review to full text selection. Those reading an article should pay attention to inclusion and exclusion criteria, and how authors determined articles for inclusion in their final research.

  11. PRISMA Diagram & Checklist

    It is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses. The PRISMA statement consists of a 27-item checklist and a 4-phase flow diagram. These items have been adapted for use by students conducting systematic reviews as part of the course requirements for KIN 4400.

  12. The PRISMA 2020 statement: an updated guideline for reporting

    A template PRISMA flow diagram is provided, which can be modified depending on whether the systematic review is original or updated (fig 1). Box 2. Noteworthy changes to the PRISMA 2009 statement. ... MJP conducted the literature review, administered the survey and analysed the data for both. MJP prepared all materials for the development meeting.

  13. PRISMA 2020 and PRISMA-S: common questions on tracking records and the

    With the new PRISMA 2020 flow diagram template, systematic review teams now have the opportunity to better represent the complexity of the search process . ... PRISMA-S: an extension to the PRISMA statement for reporting literature searches in systematic reviews. Syst Rev. 2021. Jan 26; 10 (1):39. DOI: 10.1186/s13643-020-01542-z.

  14. Step 6: PRISMA Flow Diagram & Screen

    Your systematic review can be documented using the PRISMA Flow Diagram: The PRISMA flow diagram visually summarises the screening process. It initially records the number of articles found and then makes the selection process transparent by reporting on decisions made at various stages of the systematic review.

  15. Understanding a PRISMA Flow Diagram

    The flow diagram (also called flowchart or flow chart) is typically the first figure in the results section of your systematic review . A PRISMA flow diagram visually depicts the reviewers' process of finding published data on the topic and how they decided whether to include it in the review. From a PRISMA diagram, the reader can quickly and ...

  16. Step 10: Templates, Write & Publish

    The PRISMA statement can be followed to ensure reliable coverage of the systematic review methods, results and conclusions. The PRISMA Elaboration and Explanation (E&E) document that accompanies the PRISMA statement provides instructions for each of the items on the checklist.

  17. PDF The PRISMA 2020 statement: an updated guideline for reporting ...

    content in PRISMA 2020 (table 2). A template PRISMA flow diagram is provided, which can be modified depending on whether the systematic review is original or updated (fig 1). We recommend authors refer to PRISMA 2020 early in the writing process, because prospective consideration of the items may help to ensure that all the items are addressed.

  18. PRISMA 2020 flow diagram template for systematic reviews. The new

    Download scientific diagram | PRISMA 2020 flow diagram template for systematic reviews. The new design is adapted from flow diagrams proposed by Boers [55], Mayo-Wilson et al. [56] and Stovold et ...

  19. The PRISMA 2020 statement: an updated guideline for reporting

    This abstract checklist is an update of the 2013 PRISMA for Abstracts statement , reflecting new and modified content in PRISMA 2020 (Table 2). A template PRISMA flow diagram is provided, which can be modified depending on whether the systematic review is original or updated (Fig. 1).

  20. Tailored PRISMA 2020 flow diagrams for living systematic reviews: a

    Background: While the PRISMA flow diagram is widely used for reporting standard systematic reviews (SRs), it was not designed for capturing the results of continual searches for studies in living systematic reviews (LSRs).The objectives of this study are (1) to assess how published LSRs report on the flow of studies through the different phases of the review for the different updates; (2) to ...

  21. PRISMA flow diagram

    The PRISMA flow diagram illustrates the flow of studies through the different stages of a systematic or other literature review. It provides details on the number of studies identified, included and excluded and the reasons for exclusion at full text review. Covidence provides a template that now aligns with PRISMA 2020 for a systematic ...

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    Object moved to here.

  23. Research Guides: Literature Reviews: Concept Mapping

    Literature Reviews. A concept map or mind map is a visual representation of knowledge that illustrates relationships between concepts or ideas. It is a tool for organizing and representing information in a hierarchical and interconnected manner. At its core, a concept map consists of nodes, which represent individual concepts or ideas, and ...