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Step by step help guide to accompany the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2009 flow diagram

Smith, Julie

McCormick, Kirsten

Page 1 
Last updated: 14 May 2021 
 
PRISMA 2009 Help Guide 
 
(This guide should be used with the enhanced flow diagram on Page 3).  
Identification  
Preparation 
To begin download a copy of the PRISMA flow diagram to record your searches. Your flow 
diagram should report all database searches completed and provide a combined total (you may 
wish to specify totals for individual databases using bullet points). Check with assignment 
guidance/supervisor for clarification if required.  
Box 1: Records identified through database searching 
For each database apply your search strategy and relevant limits (e.g. date range, language, etc.) 
After completing all searches, you should have your final number of records. Enter this number 
in Box 1 of the PRISMA flow diagram (top left box). 
Box 2: Additional records identified through other sources 
Box 2 enables you to report any results which have not been retrieved through database 
searching (or you have been unable to retrieve) e.g.  
• manual searches through reference lists of articles you have found, 
• search engines like Discover, Google Scholar, Mednar 
• hand searching key journals in your subject field  
Enter the total number of records identified in Box 2 (top right of the flow diagram). 
Box 3: Records after duplicates removed 
To avoid reviewing duplicate results, you need to remove any records that appear more than 
once. Removing duplicates can be done manually if you have smaller numbers of results. Or you 
may wish to consider using tools such as Excel or reference management tools e.g. Refworks. 
This would be recommended if you have a large number of records. 
Export your search results to your chosen tool (including citation and abstract) and use the 
relevant functionality to obtain a duplicate count.   
Enter the number of records left after you have removed the duplicates in Box 3. 
Page 2 
Last updated: 14 May 2021 
Screening  
Box 4: Records screened  
Indicate the number of results you will screen by title/abstract so in Box 4 enter the same 
number entered in Box 3 Records after duplicates removed. 
At this stage you are screening by title/abstract for records which are relevant to your research 
question. Include any records that appear to answer to your research criteria (if any query 
include at this stage, and screen for eligibility after reviewing the full-text article). 
Box 5: Records excluded    
Enter the number of records excluded based on title/abstract screening in Box 5 with brief 
reasons for exclusion, it may be useful to provide succinct bullet points. 
Eligibility  
Box 6: Full-text articles assessed for eligibility  
In Box 6 enter the number of records you have left after subtracting the number of excluded 
records following title/abstract screening i.e. Box 4 Records screened minus Box 5. Records 
excluded = the number of records you will screen by full-text.  
Find and review full-text articles for eligibility. Only records that are relevant and answer your 
research criteria should be included. Your final number may be determined by assignment 
guidance. Check with department or supervisor if clarification required. 
Any articles not available within GCU Library or open access via Google Scholar can be requested 
via Inter Library Loan. 
Box 7: Full-text articles excluded, with reasons 
Enter the number of records excluded at this stage in Box 7 with reasons for exclusion, it may 
useful to provide succinct bullet points. Reasons may be similar to those used at the 
title/abstract screening stage.  
Included  
The final step is to subtract the number of excluded records after full–text screening i.e.  
Box 6 Full-text articles assessed for eligibility minus Box 7 Full-text articles excluded, with 
reasons = your final number of records (this may be determined by assignment guidance).   
If you are required to indicate the type of studies identified use:  
Box 8: Studies included in qualitative synthesis  
or Box 9: Studies included in quantitative synthesis (meta-analysis) 
Alternatively, you can edit one of the boxes to match the example below and remove any 
surplus boxes in your diagram.  
  
 
Enter your final number in the appropriate box. You have now completed your PRISMA flow 
diagram and you can include in the results section of your assignment or as an appendix (check 
your departmental/assignment guidance for clarification). 
Library Ask & Learn: PRISMA 2009 help guide. This guide is based on Writing up your search strategy using PRISMA by Marion Kelt and Larissa 
Kempenaar, GCU and a work at http://www.prisma-statement.org/index.htm. Licensed under a Creative Commons Attribution 4.0 International License. 
 
Studies included in 
critical review  
(n =  ) 
Page 3 
Last updated: 14 May 2021 
 
PRISMA 2009 Flow Diagram 
 
Records identified through 
database searching 
(n =   ) 
Box 1 
 
 
Sc
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in
g 
In
cl
ud
ed
 
El
ig
ib
ili
ty
 
Id
en
tif
ic
at
io
n 
Additional records identified 
through other sources 
(n =   ) 
Box 2 
Records after duplicates removed 
(n =   ) 
Box 3 
Records screened 
(n =   ) 
Box 4 
Records excluded 
(n =   ) 
Box 5 
Full-text articles assessed 
for eligibility 
(n =   ) 
Box 6  
Full-text articles excluded, 
with reasons 
(n =   ) 
Box 7 
Studies included in 
qualitative synthesis 
(n =   ) 
Box 8 
Studies included in 
quantitative synthesis 
(meta-analysis) 
(n =   ) 
Box 9  
 
   
From:  Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews 
 and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097  
For more information, visit www.prisma-statement.org. 


PRISMA 2009 Help Guide

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