PRISMA for systematic reviews and meta-analyses

By Avishek Majumder on March 19, 2019
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The PRISMA framework or Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), is a set of guidelines or steps developed by Moher, (2013). These steps are useful for systematic literature reviews, critical literature analyses and meta-analyses. The PRISMA tool or framework uses a set of methods to systematically search papers and literature for review based studies. In addition, PRISMA is also based on the formulated inclusion and exclusion criteria in any type of study that systematically assesses the quality of chosen papers and either includes for the study or excludes for the study.

PRISMA is used mostly in medical and pharmaceutical researches, however, in recent years the use of PRISMA is also done in management studies and other non-medical studies.

The PRISMA concept

There are a few important things to note while formulating PRISMA. The PRISMA is based on the 27-item quality checklist broadly divided into:

  • Title,
  • Abstract,
  • Introduction,
  • Methods,
  • Results,
  • Discussion and,
  • Funds (Moher, 2013).

It is not mandatory to use all the checklist items; however, the inclusion and exclusion criteria are mostly based on the checklist items. The main role of the PRISMA checklist is to identify the quality of the papers identified using search strategies and the databases. In addition, the flow chart of PRISMA is based on 4 stages:

  1. identification,
  2. screening,
  3. eligibility and,
  4. included.

The PRISMA checklist

Section/topicSl. No.Checklist itemLevel of importance
Title1Identify the report as a systematic review, meta-analysis, or both, or the type of paper and the title scope.High
Abstract2Clarity of the study with; background, aim, methods used, findings, conclusion and other relevant information.High
Introduction3Must have a rationale.High
 4Must mention the objectives of the studyHigh
Methods5Protocol registration.Low
 6Eligibility criteria mentioned.Moderate
 7Information sources or the data collection sources.High
 8Search strategies or the research paradigm/philosophy.Moderate
 9Study selection or the research approach.Moderate
 10Data collection process or the sample size.High
 11Data items.Moderate
 12Risk of bias in individual studies.Low
 13Summary measures or the tools of analysisHigh
 14Synthesis of results or the methods of analysisHigh
 15Risk of bias across studiesLow
 16Additional analysesLow
Results17Study selection or the key findingsHigh
 18Study characteristics or statistical presentationsHigh
 19Risk of bias within studiesLow
 20Results of individual studies or graphs and tabular presentationsHigh
 21Synthesis of resultsLow
 22Risk of bias across studiesLow
 23Additional analysisLow
Discussion24Summary of evidenceModerate
 25LimitationsHigh
 26ConclusionsHigh
Funding27Information about funding or author conflictLow

Steps of forming the PRISMA framework

Step 1: Identify the papers on the basis of search strategies and the relevant databases used for searching and collecting research papers. Most common databases of literature include:

  • Google Scholar,
  • Embase,
  • IEEE Xplore,
  • EBSCO,
  • Cochrane and,
  • PubMed.

The first step does not involve inclusion or exclusion of papers.

Step 2: Screening the papers will involve using the quality checklist in stages. The first screening uses both the inclusion or exclusion criteria and the quality checklist to exclude the irrelevant papers.

Step 3: Check if the title of the papers found are corroborating the current study. In addition, include or exclude papers on the basis of availability of full text papers.

Step 4: Then check if the papers are in their specified language. Most scholars use English; however other may use their local languages like French, Japanese, Spanish and others. Inclusion or exclusion of papers are in this steps also seeks identify duplicate papers. This step only checks the 1st and 2nd checklist item.

Step 5: The main and the most important step is Eligibility of the papers. Prioritize to use the quality checklist in finding the eligibility of the papers. Use all or some of the checklist items on the basis of the criticalness of the papers.

Step 6: The last step involves critically reviewing the papers to address the aim of the current study.

The PRISMA flowchart (Moher, 2013)
The PRISMA flowchart (Moher, 2013)

Preparing the PRISMA flowchart

1. Identify the total number of papers collected from different papers and mention the sources.

2. Presenting the excluded and the included from the 1st screening and mention the reason for exclusion.

3. Again presenting the excluded papers while keeping in count that the number of included papers now is n=2153. Check the eligibility of the papers elected on the basis of the quality checklist items and present the reason for excluding the papers.

4. Repeat the step if needed where the number of papers included stands at 368.

5. Present the final number of papers included.

6. Include the eligibility and screening test again if the study further focuses on Meta-analysis.

References

Avishek Majumder
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