PRISMA 2020 Checklist: Item-by-Item Guide

Here's a practical walkthrough organized by the sections your manuscript actually needs.

Title and Abstract

Item 1 requires that your title identify the report as a systematic review (and specify meta-analysis, if applicable). Item 2 requires a structured abstract following the PRISMA-for-Abstracts format -- background, objectives, methods, results, discussion, and, for registered reviews, the registration number.

Introduction

Items 3 and 4 cover your rationale (why this review is needed, given what's already known) and your objectives, framed explicitly using your PICO(S) elements. A common gap here: stating that a gap in the literature exists without citing what prior reviews already covered and why yours goes further.

Methods (the largest section, items 5-15)

This is where most PRISMA compliance issues actually surface:

- **Eligibility criteria (item 5):** must be specific enough that another researcher could apply them without ambiguity. - **Information sources (item 6):** every database searched, plus any additional sources like trial registries or reference list checks, with the date of the last search. - **Search strategy (item 7):** full search strings for at least one database, in a supplement if not in the main text. - **Selection process (item 8):** how many reviewers screened, independently or not, and how disagreements were resolved. - **Data collection process (item 9):** how data was extracted and whether it was verified by a second reviewer. - **Data items (item 10):** every outcome and variable extracted, including how you handled multiple effect measures within a single study. - **Risk of bias assessment (item 11):** the specific tool used and how many reviewers applied it. - **Effect measures (item 12):** which measures you used (risk ratio, mean difference, etc.) and why. - **Synthesis methods (item 13):** this item alone has multiple sub-parts covering how studies were grouped, what statistical methods were used, how heterogeneity was assessed, and what sensitivity analyses were planned. - **Reporting bias assessment (item 14) and certainty assessment (item 15):** whether you checked for publication bias and whether you applied GRADE or an equivalent framework.

Results (items 16-22)

Your PRISMA flow diagram (item 16a) is mandatory and needs to show exact numbers at every stage -- records identified, duplicates removed, records screened, full texts assessed, and studies included, with reasons for exclusion at the full-text stage. Item 16b additionally requires the same information for any studies excluded from a previous version of the review, if applicable. The remaining items cover study characteristics, risk-of-bias results, and the results of each individual synthesis.

Discussion (items 23a-23d)

Requires an explicit discussion of your review's limitations, not just its findings -- both limitations of the included evidence and limitations of your own review process.

Other Information (items 24-27)

Covers registration and protocol details (including any deviations from your registered protocol, which must be disclosed, not just implemented silently), support/funding, competing interests, and data availability.

Where manuscripts most often fall short

Beyond missing items outright, the most common gap is *inconsistency* -- a search strategy described in the methods that doesn't match the actual search string in the supplement, or a flow diagram whose numbers don't reconcile with the results section. A methods reviewer checking PRISMA compliance will cross-reference these sections, so internal consistency matters as much as completeness.

If you're finalizing a manuscript and want a full PRISMA compliance check before submission -- item by item, cross-referenced against your actual data -- that's exactly the editing service we provide.

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