Strata Academy
PRISMA 2020 checklist explained – reporting systematic reviews and meta-analyses
Flow diagram, 27-item checklist, registration, search strategy reporting, and how PRISMA pairs with AMSTAR 2 and ROBIS
Quick answer
PRISMA 2020 is a reporting checklist and flow diagram for systematic reviews – it documents what was done (search, screening, inclusion). It is not a quality score. Pair PRISMA with AMSTAR 2 for methodological quality and ROB 2/ROBINS-I on included studies.
1. What is PRISMA 2020?
PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) is an evidence-based minimum set of items for reporting systematic reviews and meta-analyses. The 2020 update expanded guidance for new review types, search reporting, and synthesis without meta-analysis.
PRISMA is a reporting guideline – it asks whether authors transparently described what they did. It is not the same as assessing whether the review was conducted well (AMSTAR 2) or whether included studies are biased (ROB 2 / ROBINS-I applied per study).
Think of PRISMA as answering: 'Could another team reproduce the review from the published report?' AMSTAR 2 asks: 'Did they make methodological choices that threaten validity?'
2. The PRISMA 2020 flow diagram
The flow diagram is the visual summary every systematic review reader expects. It tracks records identified, deduplicated, screened, excluded (with reasons), full-text assessed, studies included, and – where relevant – studies in qualitative and quantitative synthesis.
When appraising a review, check that exclusion counts reconcile. Large drops between screened and included without clear reasons are a reporting red flag even before you open AMSTAR 2.
- Identification – databases searched, registers, other sources, total records
- Screening – records removed before screening, records screened, records excluded
- Eligibility – reports sought, not retrieved, assessed for eligibility, exclusion reasons
- Included – studies in review, studies in synthesis, optional breakdown by design
3. Key PRISMA 2020 checklist domains
The full checklist has 27 items across title, abstract, methods, results, discussion, and other information. For student appraisal, focus on the items that most often drive reproducibility and bias.
- Protocol and registration – Was the review registered (PROSPERO, OSF) before screening? Were protocol deviations explained?
- Eligibility criteria – Clear PICO/PEO elements for participants, interventions, comparators, outcomes, study designs.
- Information sources – Which databases, date limits, grey literature, reference checking?
- Search strategy – Reproducible full strategies for at least one major database (not just 'we searched PubMed').
- Study selection – How many reviewers screened? How were disagreements resolved?
- Data extraction – Piloted forms? Duplicate extraction?
- Risk of bias in studies – Which tool per design (ROB 2, ROBINS-I, etc.)? How used in synthesis?
- Synthesis methods – Narrative only, meta-analysis, heterogeneity, sensitivity analyses?
- Certainty of evidence – GRADE or equivalent when findings support recommendations?
4. PRISMA vs AMSTAR 2 vs ROBIS
Students often conflate three tools that serve different purposes in evidence synthesis.
- PRISMA 2020 – Reporting transparency (what authors say they did).
- AMSTAR 2 – Methodological quality of the review (16 items, weak / moderate / strong ratings).
- ROBIS – Risk of bias in the systematic review process itself (protocol, study selection, synthesis).
- ROB 2 / ROBINS-I – Risk of bias in each included primary study.
- GRADE – Certainty of evidence in the body of findings.
5. How to appraise a systematic review with PRISMA
Start with title and abstract – does the abstract follow PRISMA for Abstracts structure?
Open the methods and verify registration number and date. Compare registry protocol to published methods.
Request or locate supplementary search appendices. Without full strategies, the review is not reproducible.
Map each included study design to the correct risk-of-bias tool. Reviews that apply one checklist to every design are methodologically weak.
Read results and discussion for reporting bias, funding, and conflicts. PRISMA item 27 expects declaration of competing interests.
6. PRISMA extensions and review types
Not every synthesis is a pairwise meta-analysis of RCTs. PRISMA has extensions and related guidance for different review types.
- PRISMA-P – Protocols (before results exist).
- PRISMA-S – Reporting literature searches in detail.
- PRISMA-NMA – Network meta-analyses.
- PRISMA-ScR – Scoping reviews (distinct from full systematic reviews).
- PRISMA-DTA – Diagnostic test accuracy reviews.
7. Common student errors
Treating PRISMA as a quality score – it is a reporting checklist.
Citing PRISMA in the methods but omitting the flow diagram in results.
Assuming database search without Embase or CENTRAL is adequate for all clinical topics (depends on field – note limitation).
Ignoring overlap when reviews include non-randomised and randomised studies without separate synthesis.
8. StrataResearch and systematic reviews
StrataResearch routes systematic review and meta-analysis manuscripts to AMSTAR 2, PRISMA 2020, ROBIS, and GRADE-aligned pathways – not to ROB 2 alone. Uploading a review PDF triggers study-type detection so you do not manually select the wrong framework.
Use our systematic review methodology guide for the full workflow from question to synthesis, then validate your own review report against PRISMA before submission.
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