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RESEARCH METHODS AND REPORTING PRISMA 2020 explanation and elaboration: updated guidance BMJ: first published as 10.1136/bmj.n160 on 29 March 2021. Downloaded from and exemplars for reporting systematic reviews Matthew J Page,1 David Moher,2 Patrick M Bossuyt,3 Isabelle Boutron,4 Tammy C Hoffmann,5 Cynthia D Mulrow,6 Larissa Shamseer,7 Jennifer M Tetzlaff,8 Elie A Akl,9 Sue E Brennan,1 Roger Chou,10 Julie Glanville,11 Jeremy M Grimshaw,12 Asbjørn Hróbjartsson,13 Manoj M Lalu,14 Tianjing Li,15 Elizabeth W Loder,16 Evan Mayo-Wilson,17 Steve McDonald,1 Luke A McGuinness,18 Lesley A Stewart,19 James Thomas,20 Andrea C Tricco,21 Vivian A Welch,22 Penny Whiting,18 Joanne E McKenzie1 For numbered affiliations see The methods and results of systematic makers, who would otherwise be confronted by an end of the article. overwhelming volume of research on which to base Correspondence to: M Page reviews should be reported in sufficient their decisions. To allow decision makers to assess the [email protected] trustworthiness and applicability of review findings, (ORCID 0000-0002-4242-7526) detail to allow users to assess the reports of systematic reviews should be transparent Additional material is published trustworthiness and applicability of the online only. To view please visit and complete. Furthermore, such reporting should the journal online. review findings. The Preferred allow others to replicate or update reviews. The Cite this as: BMJ 2021;372:n160 Reporting Items for Systematic reviews Preferred Reporting Items for Systematic reviews http://dx.doi.org/10.1136/bmj.n160 and Meta-Analyses (PRISMA) and Meta-Analyses (PRISMA) statement published in Accepted: 4 January 2021 2009 (hereafter referred to as PRISMA 2009)1-12 was statement was developed to facilitate designed to help authors prepare transparent accounts transparent and complete reporting of of their reviews, and its recommendations have been systematic reviews and has been widely endorsed and adopted.13 We have updated the PRISMA 2009 statement (to PRISMA 2020) to ensure updated (to PRISMA 2020) to reflect currency and relevance and to reflect advances in recent advances in systematic review systematic review methodology and terminology. methodology and terminology. Here, Scope of this guideline http://www.bmj.com/ we present the explanation and The PRISMA 2020 statement has been designed elaboration paper for PRISMA 2020, primarily for systematic reviews of studies that evaluate where we explain why reporting of the effects of health interventions, irrespective of the design of the included studies. However, the checklist each item is recommended, present items are applicable to reports of systematic reviews bullet points that detail the reporting evaluating other non-health-related interventions (for recommendations, and present example, social or educational interventions), and on 23 September 2021 by guest. Protected copyright. many items are applicable to systematic reviews with examples from published reviews. We objectives other than evaluating interventions (such hope that changes to the content and as evaluating aetiology, prevalence, or prognosis). structure of PRISMA 2020 will facilitate PRISMA 2020 is intended for use in systematic reviews that include synthesis (such as pairwise meta- uptake of the guideline and lead to analysis or other statistical synthesis methods) or do more transparent, complete, and not include synthesis (for example, because only one accurate reporting of systematic eligible study is identified). The PRISMA 2020 items are relevant for mixed-methods systematic reviews reviews. (which include quantitative and qualitative studies), but reporting guidelines addressing the presentation Systematic reviews are essential for healthcare and synthesis of qualitative data should also be providers, policy makers, and other decision 14 15 consulted. PRISMA 2020 can be used for original systematic reviews, updated systematic reviews, or SUMMARY POINTS continually updated (“living”) systematic reviews. However, for updated and living systematic reviews, The PRISMA 2020 statement includes a checklist of 27 items to guide reporting there may be some additional considerations that of systematic reviews need to be addressed. Extensions to the PRISMA 2009 In this article we explain why reporting of each item is recommended, present statement have been developed to guide reporting of bullet points that detail the reporting recommendations, and present examples 16 network meta-analyses, meta-analyses of individual from published reviews participant data,17 systematic reviews of harms,18 We hope that uptake of the PRISMA 2020 statement will lead to more systematic reviews of diagnostic test accuracy transparent, complete, and accurate reporting of systematic reviews, thus studies,19 and scoping reviews20; for these types of facilitating evidence based decision making reviews we recommend authors report their review the bmj | BMJ 2021;372:n160 | doi: 10.1136/bmj.n160 1 RESEARCH METHODS AND REPORTING in accordance with the recommendations in PRISMA We use standardised language in the explanation BMJ: first published as 10.1136/bmj.n160 on 29 March 2021. Downloaded from 2020 along with the guidance specific to the extension. and elaboration to indicate whether the reporting Separate guidance for items that should be described in recommendations for each item (which we refer to as protocols of systematic reviews is available (PRISMA-P “elements” throughout) are essential or additional. 2015 statement).21 22 Essential elements should be reported in the main report or as supplementary material for all systematic PRISMA 2020 explanation and elaboration reviews (except for those preceded by “If…,” which PRISMA 2020 is published as a suite of three should only be reported where applicable). These papers: a statement paper (consisting of the 27-item have been selected as essential because we consider checklist, an expanded checklist that details reporting their reporting important for users to assess the recommendations for each item, the PRISMA 2020 trustworthiness and applicability of a review’s findings, abstract checklist, and the revised flow diagram23); or their reporting would aid in reproducing the findings. a development paper (which outlines the steps Additional elements are those which are not essential taken to update the PRISMA 2009 statement and but provide supplementary information that may provides rationale for modifications to the original enhance the completeness and usability of systematic items24); and this paper, the updated explanation review reports. The essential and additional elements and elaboration for PRISMA 2020. In this paper, for are framed in terms of reporting the “presence” of a each item, we explain why reporting of the item is method or result (such as reporting if individuals were recommended and present bullet points that detail contacted to identify studies) rather than reporting on the reporting recommendations. This structure is new their absence. In some instances, however, reporting to PRISMA 2020 and has been adopted to facilitate the absence of a method may be helpful (for example, implementation of the guidance.25 26 Authors familiar “We did not contact individuals to identify studies”). with PRISMA 2020 may opt to use the standalone We leave these decisions to the judgment of authors. statement paper23; however, for those who are new to Finally, although PRISMA 2020 provides a template or unfamiliar with PRISMA 2020, we encourage use for where information might be located, the suggested of this explanation and elaboration document. Box location should not be seen as prescriptive; the guiding 1 includes a glossary of terms used throughout the principle is to ensure the information is reported. PRISMA 2020 explanation and elaboration paper. 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 http://www.bmj.com/ Box 1: Glossary of terms relevant information for some items already appears in • Systematic review—A review that uses explicit, systematic methods to collate and a publicly accessible review protocol, referring to the synthesize findings of studies that address a clearly formulated question27 protocol may suffice. Alternatively, placing detailed • Statistical synthesis—The combination of quantitative results of two or more studies. descriptions of the methods used or additional results This encompasses meta-analysis of effect estimates (described below) and other (such as for less critical outcomes) in supplementary methods, such as combining P values, calculating the range and distribution of files is recommended. Ideally, supplementary observed effects, and vote counting based on the direction of effect (see McKenzie files should be deposited to a general-purpose or on 23 September 2021 by guest. Protected copyright. and Brennan28 for a description of each method) institutional open-access repository that provides free • Meta-analysis of effect estimates—A statistical technique used to synthesize results and permanent access to the material (such as Open when study effect estimates and their variances are available, yielding a quantitative Science Framework, Dryad, figshare). A reference or summary of results28 link to the additional information should be included • Outcome—An event or measurement collected for participants in a study (such as in the main report. quality of life, mortality)
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