PRISMA

PRESENTED BY : NAZIA QAYYUM

SAP ID: 48541
Objectives of Presentation
Introduction of PRISMA
Identify elements of PRISMA
Understanding of PRISMA statement
Exploring the use of PRISMA
PRISMA
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.
PRISMA is a result of QUORUM (Quality of Reporting Meta-Analysis of RCTs) revisions and
editions
Aim of PRISMA
To improve the reporting of systematic reviews and meta-analyses.
It can be used as a basis for reporting systematic reviews of
evaluations of interventions.
May also be useful for critical appraisal of published systematic
reviews.
PRISMA Elements
PRISMA Statement
PRISMA Extensions
PRISMA Statement
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 Checklist
PRISMA 2020 checklist (a 27-item checklist addressing the introduction, methods, results and
discussion sections of a systematic review report)
PRSIMA 2020 Expanded checklist (an abridged version of the reporting recommendations
presented in the Explanation and Elaboration paper)
The checklist can also be completed using a Shiny App available at 
https://prisma.shinyapps.io/checklist/
Item 1: Title
Identify the report as a systematic review
“Does routine anti-osteoporosis medication lower the risk of fractures in male subjects? An
updated systematic review with meta-analysis of clinical trials”
“Efficacy, tolerability and safety of cannabis-based medicines for cancer pain: A systematic
review with meta-analysis of randomised controlled trials”
A systematic review and meta-analysis of comprehensive interventions for pre-school children
with autism spectrum disorder (ASD)
Abstract
Introduction
Describe the rational for the review in the context of existing knowledge
In a review examining the effects of surgical treatments for women with stress urinary
incontinence, the authors report the knowledge gap and limitations of the existing evidence
base: treatment and a value-of-information (VOI) analysis to help inform the focus of further
research.”
Example-2
Author first define autism, then author focus on the evidence based importance of early
intervention. Afterwards they mentioned gaps in existing reviews due to the different
approaches of interventions and variety of outcomes and limitation faced, and highlighted the
need of a comprehensive review that covers studies with adequate quality standards and helps
in determining appropriate choice of intervention.
Objectives: Provide and Explicit statement of the objective (s) or questions (s) the
review addresses.

Example: The objective of our study was to conduct a systematic review and meta-
analysis of methodologically adequate studies in accordance with the Cochrane
Handbook, which allowed, for the first time, a comparison of different approaches to
interventions on different outcome measures
 Methods
 Eligibility criteria
 Information sources
 Search strategy
 Selection Process
 Data collection process
 Data items
 Study risk of bias assessment
 Effect measure
 Synthesis method
 Reporting bias assessment
 Certainty assessment
Eligibility Criteria
Specify the inclusion and exclusion criteria for the review and how studies were grouped for the
synthesis.
Example: Selection criteria Types of studies ( only randomized control studies) , Types of
participants, (age, ASD), terminology for Autism mentioned in DSM and ICD. Types of
intervention and outcome.
Information Sources and Search Strategy
Specify all data bases, registers, websites, organization, reference lists and other sources
searched or consulted to identify studies
Specify the date when each source was last searched or consulted
Present the full search strategies for all databases, registers and websites, including any filters
and limits used.

Example: PsycINFO, Medline via Ovid, ERIC, CINHAL, and the Cochrane Central Register of
Controlled Trials (CENTRAL) without any language restriction in 1st October 2014. Reference lists
from identified trials and review articles were manually scanned to identify any other relevant
studies. The ClinicalTrials.gov and the Cochrane Central Register of Controlled Trials (CENTRAL)
were also searched for randomized trials that were registered as completed but not yet
published.
Selection process
Specify the method used to decide whether study met the inclusion criteria of the review,
including how many reviewers screened each record and each report retrieved, whether they
worked independent, and if applicable details of the automation tools used in the process.
Example: In a review examining the effects of altering the availability or proximity of food,
alcohol, and tobacco products to change their selection and consumption, the authors report
priority screening methods and how non-English language articles were handled
Data collection and analysis
Specify the methods used to collect data from reports, including how many reviewers collected
data from each report, whether they worked independently, any processes for obtaining or
confirming data from study investigators, and if applicable, details of automation tools used in
the process.
Example :
In a review examining the association between smoking and sickness absence, the authors
report using a standardized form that was pilot tested, that one reviewer extracted data which
was checked by another reviewer, and that study authors were contacted
Data Items
List and define all outcomes for which data were sought. Specify whether all results that were
compatible with each outcome domain in each study were sought (e.g. for all measures, time
points, analyses), and if not, the methods used to decide which results to collect.
List and define all other variables for which data were sought (e.g. participant and intervention
characteristics, funding sources). Describe any assumptions made about any missing or unclear
information.
Results
Study selection
Study characteristics
Risk of bias in studies
Results of individual studies
Results of syntheses
Reporting biases
Certainty of evidence
Discussion
Provide a general interpretation of the results in the context of other evidence.
Discuss any limitations of the evidence included in the review.
Discuss any limitations of the review processes used.
Discuss implications of the results for practice, policy and future research
Other information
Registration and protocol
Support
Competing interests
Availability of data code and other material
PRISMA Flow diagram
Different options in flow diagram are available depending on the
search, new review or updating a review
PRISMA –Flow diagram

PRISMA 2020 flow diagram for new systematic reviews which included searches of
databases and registers only
PRISMA 2020 flow diagram for new systematic reviews which included searches of
databases, registers and other sources
PRISMA 2020 flow diagram for updated systematic reviews which included searches of
databases and registers only
PRISMA 2020 flow diagram for updated systematic reviews which included searches of
databases, registers and other sources
Flow diagrams can also be generated using a Shiny App available at 
https://www.eshackathon.org/software/PRISMA2020.html
PRISMA 2020 flow diagram for new systematic reviews
which included searches of databases and registers only
PRISMA 2020 flow diagram for new systematic reviews
which included searches of databases, registers and other
sources
PRISMA 2020 flow diagram for updated systematic
reviews which included searches of databases and
registers only
PRISMA 2020 flow diagram for updated systematic reviews
which included searches of databases, registers and other
sources
Step by Step PRSIMA Flow Diagram
Step 1: Preparation (save a copy of the diagram to use alongside searches)  
Step 2: Doing the Database Search 
◦ Search each data base individually
◦ Use different search terms
◦ Decide limits like years of search, language etc.
◦ Note down final number of articles from all databases and enter in top left box, Databases (n=).
Step 3: Remove All Duplicates 
◦ By exporting entire list of articles from each database using a citation manager (EndNote, Sciwheel, Zotero, or
Mendeley)
◦ Enter the number of records removed as duplicates in the second box
Step 4: Records Screened- Title/Abstract Screening 
• add the number of articles that you will screen. This should be the number of records
identified minus the number from the duplicates removed box.
Step 5: Records Excluded- Title/Abstract Screening 
• screen the titles and abstracts for articles which are relevant to research question.
• Record the number of articles excluded through title/abstract screening in the box to the right
titled "Records excluded." 
• Reasons of exclusion can be mentioned (optional)

Step 6: Reports Sought for Retrieval (number of articles obtained for full text screening)
Step 7: Reports Not Retrieved List the number of articles for which you are unable to find the
full text. 
Step 8: Reports Assessed for Eligibility- Full Text Screening  This should be the number of reports
sought for retrieval (Step 6) minus the number of reports not retrieved (Step 7). Review the full text
for these articles to assess their eligibility for inclusion in your systematic review. 

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

 
Step 10: Included Studies The final step is to subtract the number of records excluded during the
eligibility review of full-texts (Step 9) from the total number of articles reviewed for eligibility (Step
8). Enter this number in the box labeled "Studies included in review," combining numbers with your
grey literature search results in this box if needed.
PRISMA- Extension
 PRISMA for Abstracts
 PRISMA for Acupuncture
 PRISMA for Diagnostic Test Accuracy
 PRISMA for EcoEvo
 PRISMA Equity
 PRISMA Harms (for reviews including Harm outcomes)
 PRISMA Individual Patient Data
 PRISMA for Network Meta-Analyses
 PRISMA for Protocols
 PRISMA for Scoping Reviews
PRISMA for Abstract
PRISMA for Acupuncture
PRISMA for Acupuncture (PRISMA - A)
The PRISMA extension for acupuncture was published in 2019. The checklist includes five new
sub-items (including sub items) and six modified items to be used when conducting systematic
reviews of acupuncture interventions.
Statement paper:
Wang X, Chen Y, Liu Y, Yao L, Estill J, Bian Z, et al. Reporting items for systematic reviews and
meta-analyses of acupuncture: the PRISMA for acupuncture checklist. BMC Complementary and
Alternative Medicine. 2019 Aug 12;19(1):208. doi: 10.1186/s12906-019-2624-3.
PRISMA for Diagnostic Test Accuracy

The PRISMA extension for Diagnostic Test Accuracy (DTA) Studies was published in 2018. The 27-item PRISMA
diagnostic test accuracy checklist provides specific guidance for reporting of systematic reviews. The PRISMA
diagnostic test accuracy guideline can facilitate the transparent reporting of reviews, and may assist in the
evaluation of validity and applicability, enhance replicability of reviews, and make the results from systematic
reviews of diagnostic test accuracy studies more useful.
Statement paper:
McInnes MDF, Moher D, Thombs BD et al. Preferred Reporting Items for a Systematic Review and Meta-analysis
of Diagnostic Test Accuracy Studies: The PRISMA-DTA Statement. JAMA. 2018;319(4):388-396 [PMID: 29362800; 
DOI: 10.1001/jama.2017.19163]
Explanation and Elaboration paper:
Preferred reporting items for journal and conference abstracts of systematic reviews and meta-analyses of
diagnostic test accuracy studies (PRISMA-DTA for Abstracts): checklist, explanation, and elaboration 
BMJ 2021;372:n265
PRISMA for EcoEvo
The PRISMA-EcoEvo extension was published in 2021. The main text provides a 27-item checklist
and guidance for reporting systematic reviews and meta-analyses of primary research in ecology
and evolutionary biology. The Supporting Information provides results of surveys to assess
perceptions and standards of reporting quality of systematic reviews and meta-analyses
published in ecology and evolutionary biology, and examples of each reporting item from a
published paper in the field.
Statement / Explanatory paper:
O'Dea, R.E., Lagisz, M., Jennions, M.D., Koricheva, J., Noble, D.W., Parker, T.H., Gurevitch, J.,
Page, M.J., Stewart, G., Moher, D. and Nakagawa, S. (2021), Preferred reporting items for
systematic reviews and meta-analyses in ecology and evolutionary biology: a PRISMA extension.
Biol Rev. doi:10.1111/brv.12721
PRISMA-Equity
The PRISMA-Equity extension was published in 2012. It provides guidance for reporting equity-
focused systematic reviews in order to help reviewers identify, extract, and synthesize evidence on
equity in systematic reviews. Health inequity is defined as unfair and avoidable differences in
health.
Statement paper:
Welch V, Petticrew M, Tugwell P, Moher D, O'Neill J, Waters E, et al. (2012) PRISMA-Equity 2012
Extension: Reporting Guidelines for Systematic Reviews with a Focus on Health Equity. PLoS Med
9(10): e1001333. doi:10.1371/journal.pmed.1001333
Explanation and Elaboration:
Welch V, Petticrew M, Petkovic J, Moher D, Waters E, White H, et al. Extending the PRISMA
Statement to Equity-Focused Systematic Reviews (PRISMA-E 2012): Explanation and elaboration. J
Clin Epidemiol. Elsevier; 2015 Sep 10; doi:10.1016/j.jclinepi.2015.09.001
PPRISMA for reviews including harms
outcomes
The PRISMA harms checklist contains four extension items that must be used in any systematic review addressing
harms, irrespective of whether harms are analysed alone or in association with benefits. These include:
Item 1—title: specifically mention “harms” or other related terms, or the harm of interest in the systematic review.
Item 14—synthesis of results: specify how zero events were handled, if relevant.
Item 18—study characteristics: define each harm addressed, how it was ascertained (eg, patient report, active
search), and over what time period.
Item 21—synthesis of results: describe any assessment of possible causality.
These items are added to the original PRISMA statement, such that a systematic review addressing adverse events
should report the PRISMA statement items and the PRISMA harms.
We also added recommendations for reporting harms in systematic reviews for those items in the original PRISMA
checklist that require special consideration when reporting on harms, these items can be seen in the checklist as
"recommendations for reporting harms in systematic reviews", they are desirable items to be reported for a more
complete information of harms.
PRISMA for Individual Patient Data
systematic reviews (PRISMA-IPD)
PRISMA-IPD was published in 2015 and provides guidelines for reporting systematic reviews and
meta-analyses of IPD. Systematic reviews and meta-analyses of IPD aim to collect, check, and
reanalyze individual-level data from all studies addressing a particular research question.
Statement paper:
Stewart LA, Clarke M, Rovers M, Riley RD, Simmonds M, Stewart G, Tierney JF; PRISMA-IPD
Development Group. Preferred Reporting Items for Systematic Review and Meta-Analyses of
individual participant data: the PRISMA-IPD Statement. JAMA. 2015;313(16):1657-1665.
PRISMA for Network Meta-Analyses
(PRISMA-NMA)
The PRISMA-NMA extension was published in 2015. It provides guidance for reporting
systematic reviews comparing multiple treatments using direct and indirect evidence in network
meta-analyses. In addition to providing guidance It also highlights educational information
related to key considerations in the practice of network meta-analysis.
Statement/Explanatory paper:
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S,
Thorlund K, Jansen JP, Mulrow C, Catalá-López F, Gøtzsche PC, Dickersin K, Boutron I, Altman DG,
Moher D. The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating
Network Meta-analyses of Health Care Interventions: Checklist and Explanations. 
Ann Intern Med. 2015;162(11):777-784.
PRISMA for systematic review protocols (PRISMA-P)

PRISMA-P was published in 2015 aiming to facilitate the development and reporting of
systematic review protocols. For more information about review protocols, see here
Statement paper:
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA.
Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015
statement. Syst Rev. 2015;4(1):1. doi: 10.1186/2046-4053-4-1
Explanation and Elaboration paper:
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, the
PRISMA-P Group. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols
(PRISMA-P) 2015: elaboration and explanation. BMJ 2015.349:g7647. doi: 10.1136/bmj.g7647
PRISMA for Scoping Reviews
The PRISMA extension for scoping reviews was published in 2018. The checklist contains 20
essential reporting items and 2 optional items to include when completing a scoping review.
Scoping reviews serve to synthesize evidence and assess the scope of literature on a topic.
Among other objectives, scoping reviews help determine whether a systematic review of the
literature is warranted.
Statement / Explanatory paper
Tricco, AC, Lillie, E, Zarin, W, O'Brien, KK, Colquhoun, H, Levac, D, Moher, D, Peters, MD, Horsley,
T, Weeks, L, Hempel, S et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and
explanation. Ann Intern Med. 2018,169(7):467-473. doi:10.7326/M18-0850.
PRISMA for Searching
The PRISMA extension for searching was published in 2021. The checklist includes 16 reporting
items, each of which is detailed with exemplar reporting and Rationale.
Statement / Explanatory paper
Rethlefsen ML, Kirtley S, Waffenschmidt S, Ayala AP, Moher D, Page MJ, Koffel JB; PRISMA-S
Group. 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. PMID:
33499930; PMCID: PMC7839230.
Extensions in Development
The following PRISMA extensions are in development in collaboration with the PRISMA group:
Preferred Reporting Items for Systematic reviews and Meta-Analyses – for Children (PRISMA-C)
Preferred Reporting Items for Systematic reviews and Meta-Analyses – Protocols for Children (PR
ISMA-PC)
PRISMA guideline for systematic reviews of outcome measurement instruments, called PRISMA-
COSMIN
References

https://www.prisma-statement.org/PRISMAStatement/
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