PRISMA 2020: Reporting a Systematic Review Without Hiding the Methods

What PRISMA is

PRISMA 2020 is a reporting guideline for systematic reviews. Its 27-item checklist helps authors report why the review was done, what methods were used, what was found and how results were interpreted. It does not by itself make a review methodologically rigorous.

Before writing

• State a clear review question and eligibility criteria.
• Describe all information sources and the full search strategy sufficiently for replication.
• Report selection, data collection, risk-of-bias and synthesis methods.
• If a protocol/registration exists, report it and explain important deviations.

Flow diagram reasoning

• Track records identified, removed before screening, screened, excluded, sought for retrieval, assessed and included.
• Keep counts internally consistent with screening software and manuscript text.
• Report reasons for full-text exclusion at the appropriate stage.
• Do not fabricate a clean flow after the fact; preserve an audit trail during screening.

Results and interpretation

• Report study characteristics and risk-of-bias results alongside synthesis findings.
• Present effect estimates and uncertainty where applicable.
• Discuss heterogeneity, limitations of included evidence and limitations of the review process.
• Separate certainty-of-evidence judgments from statistical significance.

Common mistakes and clinical pearls

• PRISMA is not a risk-of-bias tool and is not a substitute for a protocol.
• A PRISMA flow diagram does not prove that screening was unbiased.
• Do not cite only the abstract checklist when writing a full review.
• Clinical pearl: complete the checklist against the final manuscript and record the page/section where each item is reported.

Summary

PRISMA 2020 improves transparency when the checklist and flow diagram accurately reflect the review process; it cannot repair weak methods that were never performed.